目的 探討右美托咪定或瑞芬太尼復(fù)合七氟烷對(duì)顱內(nèi)動(dòng)脈瘤介入手術(shù)患者血流動(dòng)力學(xué)、神經(jīng)功能及蘇醒質(zhì)量的影響。方法 選取2019年1月—2020年3月在南陽(yáng)南石醫(yī)院行顱內(nèi)動(dòng)脈瘤介入術(shù)80例患者作為研究對(duì)象，以隨機(jī)數(shù)字表法簡(jiǎn)單隨機(jī)分組為對(duì)照組與觀察組各40例。對(duì)照組給予瑞芬太尼復(fù)合七氟烷，觀察組給予鹽酸右美托咪定復(fù)合七氟烷。比較兩組麻醉誘導(dǎo)前（T0）、氣管插管后1 min（T1）、手術(shù)開(kāi)始（T2）、拔管前（T3）、拔管后10 min（T4）血流動(dòng)力學(xué)指標(biāo)變化，評(píng)價(jià)術(shù)前、術(shù)后1周、術(shù)后2周美國(guó)國(guó)立衛(wèi)生研究院卒中量表（NIHSS）評(píng)分、Barthel指數(shù)，以及蘇醒質(zhì)量。結(jié)果 觀察組心率（HR）、平均動(dòng)脈壓（MAP）、顱內(nèi)壓（ICP）在T1、T2、T3、T4時(shí)明顯低于對(duì)照組（P<0.05）。觀察組NIHSS評(píng)分在術(shù)后1周、2周明顯低于對(duì)照組，Barthel指數(shù)明顯高于對(duì)照組（P<0.05）。觀察組蘇醒時(shí)間、拔管時(shí)間明顯長(zhǎng)于對(duì)照組（P<0.05），拔管后躁動(dòng)發(fā)生率觀察組（5.00%）明顯低于對(duì)照組（20.00%）（P<0.05）。結(jié)論 相對(duì)于瑞芬太尼復(fù)合七氟烷，鹽酸右美托咪定復(fù)合七氟烷應(yīng)用于顱內(nèi)動(dòng)脈瘤介入手術(shù)，可更有效穩(wěn)定血流動(dòng)力學(xué)，改善神經(jīng)功能，提高麻醉蘇醒質(zhì)量。

Objective To explore the effect of dexmedetomidine or remifentanil combined with sevoflurane on hemodynamics, nerve function, and recovery quality of patients undergoing intracranial aneurysm intervention. Methods A total of 80 patients undergoing intracranial aneurysm interventional surgery in Nanshi Hospital of Nanyang from January 2019 to March 2020 were selected as the research subjects, and were randomly divided into control group and observation group with 40 patients in each group by random number table method. Patients in the control group were given remifentanil combined with sevoflurane, and the observation group were given dexmedetomidine combined with sevoflurane. Hemodynamic changes before anesthesia induction (T0), 1 min after endotracheal intubation (T1), the beginning of surgery (T2), before extubation (T3), and 10 min after extubation (T4) were compared between two groups. National Institutes of Health Stroke Scale (NIHSS) score and Barthel index were compared before, 1 week and 2 weeks after surgery. And the quality of awakening were observed. Results Heart rate (HR), mean arterial pressure (MAP), and intracranial pressure (ICP) in observation group were significantly lower than those in control group at T1, T2, T3 and T4 (P < 0.05). NIHSS score of the observation group was significantly lower than that of the control group 1 and 2 weeks after surgery, and Barthel index was significantly higher than those of the control group (P < 0.05). The recovery time and extubation time in the observation group were significantly longer than those in the control group (P < 0.05). The incidence of post-extubation agitation in the observation group (5.00%) was significantly lower than that in the control group (20.00%) (P < 0.05). Conclusion Compared with remifentanil and sevoflurane, the application of dexmedetomidine hydrochloride and sevoflurane in interventional surgery for intracranial aneurysm can more effectively stabilize hemodynamics, improve neurological function and improve the quality of anesthesia recovery.

R982

河南省醫(yī)學(xué)科技攻關(guān)計(jì)劃項(xiàng)目（201806281）