中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2018, Vol. 13 ›› Issue (2): 280-288.doi: 10.4103/1673-5374.226399

• 原著:脑损伤修复保护与再生 • 上一篇    下一篇

脑电双频指数监测盐酸右美托咪定复合七氟醚快通道麻醉在颅内动脉瘤栓塞应用中的神经保护效应

  

  • 收稿日期:2017-10-14 出版日期:2018-02-15 发布日期:2018-02-15
  • 基金资助:

    中国国家自然科学基金项目（81671891）

Neuroprotective effect of bispectral index-guided fast-track anesthesia using sevoflurane combined with dexmedetomidine for intracranial aneurysm embolization

Chao-liang Tang1, Juan Li2, Zhe-tao Zhang3, Bo Zhao1, Shu-dong Wang2, Hua-ming Zhang2, Si Shi1, Yang Zhang4, Zhong-yuan Xia1   

  1. 1 Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
    2 Department of Anesthesiology, Anhui Provincial Hospital of Anhui Medical University, Hefei, Anhui Provence, China
    3 Department of Pharmacy, Anhui Provincial Hospital of Anhui Medical University, Hefei, Anhui Provence, China
    4 Department of Neurosurgery, Anhui Provincial Hospital of Anhui Medical University, Hefei, Anhui Provence, China
  • Received:2017-10-14 Online:2018-02-15 Published:2018-02-15
  • Contact: Zhong-yuan Xia, M.D., Ph.D.,xiazhongyuan2005@aliyun.com.
  • Supported by:

    This study was supported by the National Natural Science Foundation of China, No. 81671891.

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摘要：

右美托咪定具有镇静、抗焦虑和止痛作用，以及抗交感及抗寒战等效应，可能用于辅助七氟醚进行麻醉，但既往尚缺乏前瞻性随机平行对照临床试验对这一假说进行验证。试验在安徽省立医院和武汉大学人民医院招募120例颅内动脉瘤栓塞患者，随机分为2组，2组患者在术中维持吸入2-3％七氟烷的基础上，一组在麻醉诱导前静脉注射1.0μg/kg右美托咪定15min内泵注完毕，之后以0.3μg/kg/h持续泵入维持麻醉；另一组仅泵入生理盐水。脑电双频指数监测结果显示右美托咪定辅助麻醉，可以缩短自主呼吸恢复时间、睁眼时间以及拔除喉罩时间，且麻醉诱导前以及拔除喉罩时葡萄糖和乳酸水平较低，S100β和神经元特异性烯醇化酶水平较低，且围手术期血压和心率更为稳定，同时术后谵妄发生较少。结果表明，右美托咪定可以有效辅助七氟醚进行颅内动脉瘤栓塞手术的麻醉，可以缩短苏醒及拔管时间，降低应激反应和能量代谢水平，稳定血流动力学参数，减少不良反应，从而发挥减低对中枢神经系统损伤的作用。试验已在中国临床试验注册中心注册，注册号ChiCTR-IPR-16008113。

orcid:0000-0002-5807-9554(Zhong-yuan Xia)

关键词: 神经再生, 右美托咪定, 七氟醚, 脑电双频指数, 快通道麻醉, 颅内动脉瘤栓塞, 应激反应, 神经保护

Abstract:

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. 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. 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. 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).

Key words: nerve regeneration, dexmedetomidine, sevoflurane, bispectral index, fast-track anesthesia, embolization of intracranial aneurysm, stress response, neuroprotection, neural regeneration