中国现代医生2023，Vol.61Issue(34)：9-13,47,6.DOI:10.3969/j.issn.1673-9701.2023.34.003
右美托咪定联合目标导向液体治疗对脑动脉瘤夹闭术患者血流动力学和脑氧供的影响
Effect of dexmedetomidine combined with goal-directed fluid therapy on hemodynamics and cerebral oxygen supply in patients undergoing cerebral aneurysm clipping
摘要
Abstract
Objective To observe the effect of dexmedetomidine combined with goal-directed fluid therapy(GDFT)on hemodynamics and cerebral oxygen supply of patients undergoing cerebral aneurysm clipping.Methods A total of 78 patients undergoing cerebral aneurysm clipping surgery in Jinhua Municipal Central Hospital from January 2021 to December 2022 were selected and divided into control group and observation group according to random number table method,with 39 cases in each group.The patients in control group received conventional fluid therapy,and the patients in observation group received dexmedetomidine pump +GDFT.Mean arterial pressure(MAP),heart rate(HR),cardiac index(CI),brain metabolic markers,neuron specific enolase(NSE),S100β levels and mini mental status examination(MMSE)scores at different time points[before anesthesia induction(T0),immediately after tracheal intubation(T1),beginning of surgery(T2),opening meninges(T3),immediately after aneurysm clipping(T4),end of surgery(T5),24h after surgery(T6),72h after surgery(T7)],and fluid intake and outflow of two groups were compared.Results MAP at T1-T4 and CI at T1-T3 in observation group were significantly higher than those in control group(P<0.05).The colloid volume,total infusion volume and urine volume in observation group were significantly higher than those in control group(P<0.05).The serum levels of NSE and S100β at T5-T7 were significantly higher than those at T0 in both groups(P<0.05).The levels of serum NSE and S100β at T5 and T6 in observation group were significantly lower than those in control group(P<0.05).The oxygen content in jugular venous blood(CjvO2)at T1-T4 was significantly lower than that at T0 in control group(P<0.05).Cerebral oxygen extraction ratio at T1 was significantly higher than that at T0 in both groups(P<0.05).CjvO2 at T3-T4 in observation group were significantly higher than those in control group(P<0.05).At T6 and T7,MMSE scores in two groups were significantly lower than at T0 in this group(P<0.05).MMSE score at T6 of observation group was significantly higher than that of control group(P<0.05).Conclusion Dexmedetomidine combined with GDFT can effectively improve preload and brain function,stabilize intraoperative circulatory function,and improve early postoperative cognitive function in patients undergoing cerebral aneurysm clipping.关键词
目标导向液体治疗/右美托咪定/脑动脉瘤夹闭/血流动力学/脑氧供Key words
Goal-directed fluid therapy/Dexmedetomidine/Cerebral aneurysm clipping/Hemodynamics/Cerebral oxygen supply分类
医药卫生引用本文复制引用
陆微,姜小峰,朱丹艳,刘晓波,彭文勇..右美托咪定联合目标导向液体治疗对脑动脉瘤夹闭术患者血流动力学和脑氧供的影响[J].中国现代医生,2023,61(34):9-13,47,6.基金项目
浙江省医药卫生科技计划项目(2020KY345) （2020KY345）
金华市中心医院院级项目(JY2018-2-11) （JY2018-2-11）
