右美托咪定对脑肿瘤手术患者的麻醉效果分析*

Comparison of anesthetic efficacy of dexmedetomidine and propofol combined anesthesia in patients with brain tumor surgery*

摘要:

目的?比较右美托咪定与丙泊酚复合麻醉对脑肿瘤手术患者的麻醉效果、血流动力学及脑保护作用。方法?选取2018年2月—2020年2月在新疆医科大学附属肿瘤医院择期行脑肿瘤手术的62例患者。其中，神经胶质瘤37例，脑膜瘤25例。采用随机数字表法分为右美托咪定组和丙泊酚组，每组31例。监测患者麻醉诱导开始前（T0）、术中切开硬脑膜时（T1）、完全去除肿瘤时（T2）、手术结束时（T3）及手术结束后24?h（T4）的心率（HR）、平均动脉压（MAP）、中心静脉氧饱和度（ScVO2）、颈内静脉氧饱和度（SjVO2）及神经元特异性烯醇化酶（NSE）、S100β蛋白水平，记录患者苏醒时间、拔管时间、拔管后警觉/镇静（OAA/S）评分及术后不良反应发生情况。结果?HR、MAP在不同时间、不同组间及变化趋势上有差异（P?<0.05）。ScVO2、SjVO2和NSE、S100β蛋白水平在不同时间、不同组间及变化趋势上有差异（P?<0.05）。右美托咪定组苏醒时间、拔管时间低于丙泊酚复合麻醉组（P?<0.05），而OAA/S评分高于丙泊酚复合麻醉组（P?<0.05）。两组不良反应发生率比较，差异无统计学意义（P?>0.05）。结论?右美托咪定较丙泊酚复合麻醉对脑肿瘤手术患者具有更好的麻醉镇静效果，有利于血流动力学稳定和脑代谢，有效保护患者脑组织，安全性较高，具有重要的临床应用价值。

关键词:脑肿瘤;右美托咪啶;丙泊酚/二异丙酚;血流动力学;疗效比较研究

Abstract:

Objective To compare the anesthetic efficacy and cerebral protective effects of dexmedetomidine (Dex) and propofol-combined anesthesia and the effects thereof on the hemodynamics of patients with brain tumor surgery. Methods From February 2018 to February 2020, 62 patients who underwent elective brain tumor surgery in our hospital, were enrolled and divided into the Dex combined anesthesia group (n?=?31) and the propofol combined anesthesia group (n?=?31) through random number table method, among which there were 37 cases of glioma and 25 cases of meningioma. The heart rate (HR), mean arterial pressure (MAP), central venous oxygen saturation (ScVO2), internal jugular venous oxygen saturation (SjVO2), and neuron-specific enolase (NSE), S100β protein levels of the patients were monitored before anesthesia induction (T0), during dural incision (T1), after tumor removal (T2), at the end of surgery (T3), and 24 hours after surgery (T4).The recovery time, extubation time, observer’s assessment of alertness/sedation (OAA/S) score after extubation and incidence of postoperative adverse reactions were recorded. Results There were differences in HR and MAP between the two groups at different time points (P??0.05). Conclusions Compared with propofol combined anesthesia, Dex combined anesthesia has a better anesthetic and sedative effect on patients undergoing brain tumor surgery, which is conducive to the stability of hemodynamics and brain metabolism, more effective protection of brain tissue and higher safety, and is of great value for clinical application.

Key words:brain tumor; dexmedetomidine; propofol; anesthetic effect; hemodynamics; brain protection