目的 探討右美托咪定或瑞芬太尼復合七氟烷對顱內動脈瘤介入手術患者血流動力學、神經功能及蘇醒質量的影響。方法 選取2019年1月—2020年3月在南陽南石醫(yī)院行顱內動脈瘤介入術80例患者作為研究對象，以隨機數(shù)字表法簡單隨機分組為對照組與觀察組各40例。對照組給予瑞芬太尼復合七氟烷，觀察組給予鹽酸右美托咪定復合七氟烷。比較兩組麻醉誘導前（T0）、氣管插管后1 min（T1）、手術開始（T2）、拔管前（T3）、拔管后10 min（T4）血流動力學指標變化，評價術前、術后1周、術后2周美國國立衛(wèi)生研究院卒中量表（NIHSS）評分、Barthel指數(shù)，以及蘇醒質量。結果 觀察組心率（HR）、平均動脈壓（MAP）、顱內壓（ICP）在T1、T2、T3、T4時明顯低于對照組（P<0.05）。觀察組NIHSS評分在術后1周、2周明顯低于對照組，Barthel指數(shù)明顯高于對照組（P<0.05）。觀察組蘇醒時間、拔管時間明顯長于對照組（P<0.05），拔管后躁動發(fā)生率觀察組（5.00%）明顯低于對照組（20.00%）（P<0.05）。結論 相對于瑞芬太尼復合七氟烷，鹽酸右美托咪定復合七氟烷應用于顱內動脈瘤介入手術，可更有效穩(wěn)定血流動力學，改善神經功能，提高麻醉蘇醒質量。

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)學科技攻關計劃項目（201806281）