脑电双频指数监测下七氟醚联合右美托咪定快诱麻醉对颅内动脉瘤栓塞患者的神经保护作用
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Neuroprotective effect of bispectral index-guided fast-track anesthesia using sevoflurane combined with dexmedetomidine for intracranial aneurysm embolization
目的
右美托咪定具有镇静、抗焦虑、镇痛、抗交感和抗寒颤的作用。右美托咪定联合七氟醚用于麻醉可能有效，但缺乏验证这一假设的前瞻性随机对照临床试验。
方 法
从安徽省立医院和中国武汉大学人民医院共纳入120例颅内动脉瘤栓塞患者，并随机分为两组。术中给予2％至3％七氟醚吸入后，一组患者静脉泵注1.0μg/ kg右美托咪定15分钟，然后以0.3μg/ kg / h维持直至手术结束; 另一组患者仅泵注生理盐水。
结 果
脑电双频指数监测显示使用右美托咪定辅助麻醉可缩短自主呼吸的恢复时间、睁眼时间和拔喉罩的时间。在麻醉诱导之前和拔喉罩后，葡萄糖和乳酸水平低，S100β和神经元特异性烯醇化酶水平低，围术期血压和心率稳定，且术后瞻妄发生率最低。
结 论
该研究结果表明右美托咪定可有效辅助七氟醚用于颅内动脉瘤栓塞手术的麻醉，缩短意识恢复时间和拔管时间，降低应激反应和能量代谢，稳定血液动力学参数，减少不良反应，从而减少对中枢神经系统的损害。
原始文献摘要
Tang CL1, Li J2, Zhang ZT3, Zhao B1, Wang SD2, Zhang HM2, Shi S1, Zhang Y4, Xia ZY1.Neuroprotective effect of bispectral index-guided fast-track anesthesia using sevofluranecombined with dexmedetomidine for intracranial aneurysm embolization.
Abstract
1. Dexmedetomidine has sedative, anxiolytic, analgesic, anti-sympathetic, and anti-shivering effects. Dexmedetomidine might be effective in combination with sevoflurane for anesthesia, but prospective randomized controlled clinical trials with which to verify this hypothesis are lacking.
2. In total, 120 patients who underwent embolization of an intracranial aneurysm were recruited from Anhui Provincial Hospital and Renmin Hospital of Wuhan University of China and randomly allocated to two groups. After intraoperative administration of 2% to 3% sevoflurane inhalation, one group of patients received pump-controlled intravenous injection of 1.0 μg/kg dexmedetomidine for 15 minutes followed by maintenance with 0.3 μg/kg/h until the end of surgery; the other group of patients only underwent pump-controlled infusion of saline.
3. Bispectral index monitoring revealed that dexmedetomidine-assisted anesthesia can shorten the recovery time of spontaneous breathing, time to eye opening, and time to laryngeal mask removal. Before anesthetic induction and immediately after laryngeal
mask airway removal, the glucose and lactate levels were low, the S100β and neuron-specific enolase levels were low, the perioperative blood pressure and heart rate were stable, and postoperative delirium was minimal.
4.These findings indicate that dexmedetomidine can effectively assist sevoflurane for anesthesia during surgical embolization of intracranial aneurysms, shorten the time to consciousness and extubation, reduce the stress response and energy metabolism, stabilize hemodynamic parameters, and reduce adverse reactions, thereby reducing the damage to the central nervous system. This trial was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn/) (registration number: ChiCTR-IPR-16008113).
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