【摘要】 目的观察不同靶控浓度右美托咪定对颅内动脉瘤患者脑氧代谢影响。方法 120例颅内动脉瘤患者随机分为A、B、C、D组,每组30例。A、B、C组分别于麻醉诱导前20 min靶控输注右美托咪定3,5,7 ng·m L^-1,D组作为对照组,泵注等量0.9%NaCl。达到靶控浓度后,4组均静脉注射长托宁、咪达唑仑、芬太尼、丙泊酚、顺-阿曲库铵行麻醉诱导,待意识消失,肌松满意后进行气管内导管插管,术中泵注瑞芬太尼、丙泊酚及间断静脉注射顺-阿曲库铵维持麻醉深度,术中维持脑电双频指数（BIS）在40⁶0。记录4组患者围手术期不同时刻血流动力学相关指标变化,并于相对应时刻抽取患者颈内静脉球部血及桡动脉血进行血气分析,计算动脉-颈内静脉球部血氧差及脑氧摄取率。结果 A组气管插管后脑氧摄取率（CEO₂）为（37.85±2.82）%,B组为（33.67±2.09）%,C组为（31.48±2.75）%,D组为（38.39±3.39）%,C组与D组比较差异均有统计学意义（P<0.05）;A组插管后5 min CEO₂为（37.06±3.29）%,B组为（33.38±2.74）%,C组为（31.82±2.61）%,D组为（38.82±2.72）%,C组与A,D组比较,差异均有统计学意义（P<0.05）;A组手术1 h CEO₂为（33.77±2.12）%,B组为（33.22±2.79）%,C组为（29.56±2.68）%,D组为（38.54±3.06）%,C组与A,B,D组比较,差异均有统计学意义（P<0.05）;A组手术2 h CEO₂为（33.21±2.79）%,B组为（34.11±3.73）%,C组为（30.34±3.41）%,D组为（38.16±3.12）%,差异均有统计学意义（P<0.05）;A组手术结束即刻CEO₂为（33.34±2.28）%,B组为（30.82±3.29）%,C组为（31.33±3.32）%,D组为（35.43±5.08）%,C组与A,D组比较,差异均有统计学意义（P<0.05）。A组出现高血压2例,药物不良反应发生率为6.67%（2/30例）;B组出现低血压1例,药物不良反应发生率3.33%（1/30例）;C组出现低血压4例,药物不良反应发生率13.33%（4/30例）;D组出现高血压5例,药物不良反应发生率为16.67%（5/30例）,差异均无统计学意义（P>0.05）。结论右美托咪定可降低颅内动脉瘤患者动脉-颈内静脉球部血氧差及脑氧摄取率,且一定范围内随着靶控浓度增加,其动脉-颈内静脉球部血氧差及脑氧摄取率随之降低。更多还原

【Abstract】 Objective To observe the clinical effect of different target-controlled concentrations of dexmedetomidine on cerebral oxygen metabolism in intracranial aneurysms patients.Methods A total of 120 patients were randomly divided into A,B,C,D group,and 30 cases in each group.According to different target-controlled concentrations of dexmedetomidine,A,B,C groups were respectively given 3,5,7 ng·m L^-1dexmedetomidine at 20 min before induction of anesthesia,and as the control group,D group was pumped pump into the equivalent 0.9% NaCl.Once achieving the target concentration,all the groups were given thorning,midazolam,fentanyl,propofol,shun-atracurium for anesthesia induction.Subsequently,the tracheal catheters were applied when patients were in the state of unconscious and muscle relaxants and penehyclidine hydrochloride,midazolam,reventani,propofol and atracurium were intermittently given to maintain depth of anesthesia and keep the bispectral index during operation（ BIS） in the range of 40-60.Hemodynamic indexes changes in different time of perioperative period were recorded and the internal jugular vein blood and radial artery blood were drawn for blood gas analysis and further the radial artery and internal jugular venous bulb oxygen poor and cerebral oxygen uptake rate were calculated for statistical analysis.The changes of hemodynamic indicators in different time undergoing surgery in four groups were observed.The artery-internal jugular bulb blood oxygen difference and cerebral oxygen uptake rate were observed at corresponding time by jugular bulb blood and radial arterial blood gas analysis.Results After endotracheal intubation,cerebral O2 extraction rate（ CEO₂） of A,B,C,D group were（ 37.85 ± 2.82） %,（ 33.67 ± 2.09） %,（ 31.48 ± 2.75） %,（ 38.39 ± 3.39） %.There was significant difference between C group and D group（ P < 0.05）.CEO₂ of A,B,C,D group at 5 min after skin incision were（ 37.06 ± 3.29） %.There was significant difference with C and D（ 33.38 ± 2.74） %,（ 31.82 ± 2.61） %,（ 38.82 ± 2.72） %.There was significant difference between C and A,D（ P < 0.05）.CEO₂ in A,B,C,D groups at 1 h after operation were（ 33.77 ± 2.12） %,（ 33.22 ± 2.79） %,（ 29.56 ± 2.68） %,（ 38.54 ± 3.06） %.There was sifnificant difference bwtween C and A,B,D（ P < 0.05）.CEO₂ in A,B,C,D group at 1 h after operation were（ 33.21 ± 2.79） %,（ 34.11 ± 3.73） %,（ 30.34 ± 3.41） %,（ 38.16 ± 3.12） %.There was sifnificant difference bwtween C and A,B,D（ P < 0.05）.At the end of operation,CEO₂ in A,B,C,D group were（ 33.34 ± 2.28） %,（ 30.82 ± 3.29） %,（ 31.33 ± 3.32） %,（ 35.43 ± 5.08） %.There was sifnificant difference between C and A,D（ P < 0.05）.In group A,there were 2 cases of hypertension,the incidence rate of adverse drug reactions was 6.67%（ 2/30）; group B had 1 case of hypotension and the incidence rate of adverse drug reactions was 3.33%（ 1/30）; group C had 4 cases of hypotension and the incidence rate of adverse drug reactions was 13.33%（ 4/30）; group D occurred 5 cases of hypertension and the incidence rate of adverse drug reactions was 16.67%（ 5/30）.The difference had no statistical significance（ P > 0.05）.Conclusion Dexmedetomidine can effectively reduce the artery-jugular bulb venous O2 content difference and cerebral oxygen extraction rate of intracranial aneurysm patients.And in a certain range,they showed the positive correlation.更多还原