摘要
目的比较右美托咪定与七氟烷复合瑞芬太尼麻醉方案在老年脑缺血患者的应用价值。方法前瞻性选取2017年6月至2018年6月西安交通大学附属红会医院收治的100例需要行颈动脉内膜剥脱的脑缺血患者,按照随机数字表法将患者分为观察组和对照组,每组各50例。两组患者均采用舒芬太尼0.2~0.4μg/kg,丙泊酚1.0~2.0 mg/kg、罗库溴铵0.6 mg/kg诱导。对照组患者采用吸入七氟烷[控制最低肺泡有效浓度(MAC)值在1.0~2.0之间],并以瑞芬太尼0.1~0.2μg·kg^-1·min^-1进行镇痛;观察组患者输注右美托咪定0.5μg·kg^-1·h^-1维持镇静和瑞芬太尼0.1~0.2μg·kg^-1·min^-1提供镇痛。记录两组患者的一般资料、颈动脉平均流速(Vmean)、平均血流量(Qmean)、脉搏波波速(Wv)及外周阻力(R)情况。比较手术前后两组患者丙二醛(MDA)、总超氧化物歧化酶(T-SOD)、γ-谷氨酰转移酶(γ-GGT)、白细胞介素-6(IL-6)浓度以及术后麻醉不良反应情况。结果两组患者的年龄、病程、收缩压、颈动脉内膜厚度比较,差异均无统计学意义(P>0.05)。两组患者术后脑血流指标均较前明显改善,观察组患者改善程度明显优于对照组(P<0.05)。术后两组患者MDA浓度显著升高,观察组患者升高程度显著低于对照组(P<0.05)。术后两组患者T-SOD浓度显著升高,观察组患者升高程度显著低于对照组(P<0.05)。术后两组患者γ-GGT浓度显著降低,但观察组患者降低程度显著大于对照组(P<0.05)。术后两组患者IL-6浓度显著升高,观察组患者升高程度显著低于对照组(P<0.05)。两组患者术后总不良反应发生率比较无显著差异(χ^2=1.02,P=0.183)。结论与七氟烷复合瑞芬太尼麻醉方案相比,右美托咪定能有效改善脑血流指标,降低老年脑缺血患者氧化应激水平以及炎症因子水平,值得临床推广。
Objective To compare the application value of dexmedetomidine and sevoflurane combined with remifentanil in elderly patients with cerebral ischemia.Methods this study was a prospective study.From June 2017 to June 2018,100 patients with cerebral ischemia who need carotid endarterectomy were selected from Red Cross Hospital Affiliated to Xi'an Jiaotong University.According to the method of random number table,the patients were divided into observation group and control group,50 cases in each group.Both groups were induced by sufentanil 0.2~0.4μg/kg,propofol 1.0~2.0 mg/kg and rocuronium 0.6 mg/kg.In the control group,sevoflurane was inhaled to control the minimum alveolar effective concentration(MAC)between 1.0 and 2.0,and remifentanil 0.1~0.2μg·kg^-1·min^-1 was used for analgesia;in the observation group,remifentanil 0.5μg·kg^-1·h^-1 was used for sedation and remifentanil 0.1~0.2μg·kg^-1·min^-1 for analgesia.The general data,vmean,qmean,WV and R of the two groups were recorded.Malondialdehyde(MDA),total superoxide dismutase(T-SOD),γ-glutamyltransferase(γ-GGT),interleukin-6(IL-6)and adverse effects of anesthesia before and after operation in the two groups.Results there was no significant difference in age,course,systolic blood pressure and carotid intimal thickness between the two groups(P>0.05).The indexes of cerebral blood flow in the two groups were significantly improved after operation,and the improvement degree in the observation group was significantly better than that in the control group(P<0.05).The level of MDA in the observation group was significantly lower than that in the control group(P<0.05).The level of T-SOD in the observation group was significantly lower than that in the control group(P<0.05).After operation,the concentration ofγ-GGT in the two groups decreased significantly,but the decrease degree in the observation group was significantly higher than that in the control group(P<0.05).The level of IL-6 in the observation group was significantly lower than that in the control group(P<0.05).There was no significant difference in the total adverse reactions between the two groups(χ^2=1.02,P=0.183).Conclusion Compared with sevoflurane combined with remifentanil anesthesia,dexmedetomidine can effectively improve cerebral blood flow index,reduce the level of oxidative stress and inflammatory factors in elderly patients with cerebral ischemia,which is worthy of clinical promotion.
作者
王海丽
吕海港
李潞
王仿
WANG Hai-li;LYU Hai-gang;LI Lu(Department of Hand and Hemp,Red Cross Hospital Affiliatedto Xi'an Jiaotong University,Xi'an Shaanxi 710054,China)
出处
《临床和实验医学杂志》
2020年第14期1556-1560,共5页
Journal of Clinical and Experimental Medicine
基金
陕西省科技计划项目(编号:2019SF-049)。
关键词
脑缺血
麻醉
右美托咪定
七氟烷
瑞芬太尼
脑血流指
标
氧化应激
炎症因子
Cerebral ischemia
Anaesthesia
Dexmedetomidine
Seven halothane
Remifentanil
Cerebral blood flow index
Oxidative stress
Inflammatory factors
