右美托咪定在神经外科麻醉中的应用与研究进展
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摘要
目的探讨右美托咪定在神经外科麻醉中的应用。方法综述右美托咪定的药理学特点并阐述其在神经外科麻醉中的最新应用进展。结果与结论右美托咪定具有潜在的神经保护、稳定血液动力学、镇痛等作用,在清醒过程中的呼吸抑制最小,故成为各种神经外科手术中的有效麻醉辅助剂。
Objective To investigate the application of dexmedetomidine in neurosurgical anesthesia. Methods The pharmacological characteristics of dexmedetomidine were summarized,and the progress of its latest application in neurosurgical anesthesia was reviewed. Results and Conclusion Dextrometridine has potential neuroprotective,hemodynamic and analgesic effects,and has the least respiratory inhibition during awakening,so it has become an effective anesthetic adjuvant in various neurosurgical operations.
Objective To investigate the application of dexmedetomidine in neurosurgical anesthesia. Methods The pharmacological characteristics of dexmedetomidine were summarized,and the progress of its latest application in neurosurgical anesthesia was reviewed. Results and Conclusion Dextrometridine has potential neuroprotective,hemodynamic and analgesic effects,and has the least respiratory inhibition during awakening,so it has become an effective anesthetic adjuvant in various neurosurgical operations.
引文
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[14] XIONG B,SBI Q,FANG H. Dexmedetomidine alleviates postoperative cognitive dysfunction by inhibiting neuron excitation in aged rats[J]. Am J Transl Res,2016,8(1):70-80.
[15] CHEN JJ,YAN J Q,HAN XP. Dexmedetomidine may benefit cognitive function after laparoscopic cholecystectomy in elderly patients[J]. Exp The Med,2013,5(2):489-494.
[16] ZHANG H,LU Y,LIU M,et al. Strategies for prevention of postoperative delirium:a systematic review and meta-analysis of randomized trials[J]. Crit Care,2013,17(2):47-55.
[17] CHI OZ,GRAYSON J,BARSOUM S,et al. Effects of dexmedetomidine on micro regional O2 balance during reperfusion after focal cerebral ischemia[J]. J Stroke Cerebrovasc Dis,2015,24(1):163-170.
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[26] HONORATO-CIA C,MARTINEZ-SIMON A,ALEGRE M,et al. Factors associated with tremor changes during sedation with dexmedetomidine in Parkinson's disease surgery[J]. Stereotact Funct Neurosurg,2015,93:393-399.
[27] TROMBETTA C,DEOGAONKAR A,DEOGAONKAR M,et al.Delayed awakening in dystonia patients undergoing deep brain stimulation surgery[J]. J Clin Neurosci,2010,17(7):865-868.
[28] ROZET I,MUANGMAN S,VAVILALA MS,et al. Clinical experience with dexmedetomidine for implantation of deep brain stimulators in Parkinson's disease[J]. Anesth Analg,2006,103(5):1224-1228.
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[30] SOLIMAN RN, HASSAN AR, RASHWAN AM, et al.Prospective,randomized study to assess the role of dexmedetomidine in patients with supratentorial tumors undergoing craniotomy under general anaesthesia[J]. Middle East J Anaesthesiol,2011,21(3):325-334.
[31] GOPALAKRISHNA KN,DASH PK,CHATTERJEE N,et al.Dexmedetomidine as an anesthetic adjuvant in patients undergoing trans-sphenoidal resection of pituitary tumor[J]. J Neurosurg Anesthesiol,2015,27(3):209-215.
[32] LIN N,HAN R,ZHOU J,et al. Mild sedation exacerbates or unmasks focal neurologic dysfunction in neurosurgical patients with supratentorial brain mass lesions in a drug-specific manner[J]. Anesthesiology,2016,124(3):598-607.
[33] WANG Y,HAN R,ZUO Z. Dexmedetomidine post-treatment induces neuroprotection via activation of extracellular signalregulated kinase in rats with subarachnoid haemorrhage[J]. Br J Anaesth,2016,116(3):384-392.
[34] YOKOTA H,YOKOYAMA K,NOGUCHI H,et al. Post-operative dexmedetomidine-based sedation after uneventful intracranial surgery for unruptured cerebral aneurysm:comparison with propofol-based sedation[J]. Neurocrit Care,2011,14(2):182-187.
[35] LEE HH,JUNG YJ,CHOI BY,et al. Usefulness of dexmedetomidine during intracerebral aneurysm coiling[J]. J Korean Neurosurg Soc,2014,55(4):185-189.
[36] GOYAGI T,NISHIKAWA T,TOBE Y,et al. The combined neuroprotective effects of lidocaine and dexmedetomidine after transient forebrain ischemia in rats[J]. Acta Anaesthesiol Scand,2009,53(19):1176-1183.
[2]宋莺春,徐飞,李汝泓.右旋美托咪啶对老年腰椎术患者的镇静效果分析及血流动力学影响[J].中国生化药物杂志,2014,34(5):135-138.
[3] FARAG E,ARGALIOUS M,SESSLER DI,et al. Use ofα2-agonists in neuroanesthesia:an overview[J]. Ochsner J,2011,11:57-69.
[4] LEHTIMKI J,LEINO T,KOIVISTO A,et al. In vitro and in vivo profiling of fadolmidine,a novel potent alpha(2)-adrenoceptor agonist with local mode of action[J]. Eur J Pharmacol,2008,599(1-3):65-71.
[5] EBERT TJ,HAIUE,BARNEY JA,et al. The effects of increasing plasma concentration of dexmedetomidine in humans[J]. Anesiology,2000,93(20):382-394.
[6] MAZC M,SCARFINI C,CAVALIERE F. New agents for sedation in the intensive care unit[J]. Crit Care Clin,2002,17(4):881-897.
[7]邬子林,许立新,佘守章.右美托咪定在手术麻醉与镇痛中的研究进展[J].广东医学,2012,33(8):1043-1045.
[8]王桂平.盐酸右美托咪定在日间手术的应用现状及研究进展[J].河北医科大学学报,2016,37(2):246-248.
[9]冷亚书,李龙云,胡宇博.右美托咪定在围术期镇痛作用的研究进展[J].中国实验诊断学,2014,18(9):1565-1567.
[10] XIA ZQ,CHEN SQ,YAO X,et al. Clinical benefits of dexmedetomidine versus propofol in adult intensive care unit patients:a meta-analysis of randomized clinical trials[J]. J Surg Res,2013,185(2):833-843.
[11] YILDIZ M,TAVLAN A,TUNCER S,et al. Effect of dexmedetomidine on haemodynamic responses to laryngoscopy and intubation perioperative haemodynamics and anaesthetic requirements[J].Drugs in R&D,2006,7(1):43-52.
[12] TSAI CJ. A comparition of the effectiveness of dexmedetomidine versus propofol target-controlled infusion for sedation during fibreoptic nasotrachealntubation[J]. Anaesthesia,2010,65(3):254-260.
[13] COSAR M,ESER O,FIDAN H,et al. The neuroprotective effect of dexmedetomidine in the hippocampus of rabbits after subarachnoid hemorrhage[J]. Surg Neurol,2009,71(1):54-59.
[14] XIONG B,SBI Q,FANG H. Dexmedetomidine alleviates postoperative cognitive dysfunction by inhibiting neuron excitation in aged rats[J]. Am J Transl Res,2016,8(1):70-80.
[15] CHEN JJ,YAN J Q,HAN XP. Dexmedetomidine may benefit cognitive function after laparoscopic cholecystectomy in elderly patients[J]. Exp The Med,2013,5(2):489-494.
[16] ZHANG H,LU Y,LIU M,et al. Strategies for prevention of postoperative delirium:a systematic review and meta-analysis of randomized trials[J]. Crit Care,2013,17(2):47-55.
[17] CHI OZ,GRAYSON J,BARSOUM S,et al. Effects of dexmedetomidine on micro regional O2 balance during reperfusion after focal cerebral ischemia[J]. J Stroke Cerebrovasc Dis,2015,24(1):163-170.
[18] TSAOUSI GG,BILOTTA F. Is dexmedetomidine a favorable agent for cerebral hemndynamics[J]. Indian J Crit Care Med,2016,20(1):1-2
[19] DOUFAS AG,LIN CM,SULEMAN MI,et al. Dexmedrtomidine and meperidine additively reduce the shivering threshold in humans[J]. Stroke,2003,34(5):1218-1223.
[20] TSAOUSI GG,LAMPERTI M,BILOTTA F. Role of dexmedetomidine for sedation in neurocritical care patients:a qualitative systematic review and Meta-analysis of current evidence[J].Clin Neuropharmacol,2016,39(3):144-151.
[21] MCAULIFFE N,NICHOLSON S,RIGAMONTI A,et al. Awake craniotomy using dexmedetomidine and scalp blocks:a retrospective cohort study[J]. Can J Anaesth,2018,65(10):1129-1137.
[22]李民,张利萍,吴新民.右美托咪啶在临床麻醉中应用的研究进展[J].中国临床药理学杂志,2007,23(6):466-470.
[23] GHAZANWY M,CHAKRABARTI R,TEWARI A,et al. Awake craniotomy:a qualitative review and future challenges[J]. Saudi J Anaesth,2014,8(4):529-539.
[24] SOKHAL N,RATH GP,CHATURVEDI A,et al. Anaesthesia for awake craniotomy:a retrospective study of 54 cases[J]. Indian J Anaesth,2015,59(5):300-305.
[25] GRANT R,GRUENBAUM SE,GERRARD J. Anaesthesia for deep brain stimulation:a review[J]. Curr Opin Anaesthesiol,2015,28(5):505-510.
[26] HONORATO-CIA C,MARTINEZ-SIMON A,ALEGRE M,et al. Factors associated with tremor changes during sedation with dexmedetomidine in Parkinson's disease surgery[J]. Stereotact Funct Neurosurg,2015,93:393-399.
[27] TROMBETTA C,DEOGAONKAR A,DEOGAONKAR M,et al.Delayed awakening in dystonia patients undergoing deep brain stimulation surgery[J]. J Clin Neurosci,2010,17(7):865-868.
[28] ROZET I,MUANGMAN S,VAVILALA MS,et al. Clinical experience with dexmedetomidine for implantation of deep brain stimulators in Parkinson's disease[J]. Anesth Analg,2006,103(5):1224-1228.
[29] ARULVELAN A,MANIKANDAN S,EASWER HV,et a1. Effect of loading dose of dexmedetomidine on dynamic cerebral blood flow autoregulation in patients with intracranial glial neoplasms[J].J Neurosurg Anesthesiol,2015,27(4):289-294.
[30] SOLIMAN RN, HASSAN AR, RASHWAN AM, et al.Prospective,randomized study to assess the role of dexmedetomidine in patients with supratentorial tumors undergoing craniotomy under general anaesthesia[J]. Middle East J Anaesthesiol,2011,21(3):325-334.
[31] GOPALAKRISHNA KN,DASH PK,CHATTERJEE N,et al.Dexmedetomidine as an anesthetic adjuvant in patients undergoing trans-sphenoidal resection of pituitary tumor[J]. J Neurosurg Anesthesiol,2015,27(3):209-215.
[32] LIN N,HAN R,ZHOU J,et al. Mild sedation exacerbates or unmasks focal neurologic dysfunction in neurosurgical patients with supratentorial brain mass lesions in a drug-specific manner[J]. Anesthesiology,2016,124(3):598-607.
[33] WANG Y,HAN R,ZUO Z. Dexmedetomidine post-treatment induces neuroprotection via activation of extracellular signalregulated kinase in rats with subarachnoid haemorrhage[J]. Br J Anaesth,2016,116(3):384-392.
[34] YOKOTA H,YOKOYAMA K,NOGUCHI H,et al. Post-operative dexmedetomidine-based sedation after uneventful intracranial surgery for unruptured cerebral aneurysm:comparison with propofol-based sedation[J]. Neurocrit Care,2011,14(2):182-187.
[35] LEE HH,JUNG YJ,CHOI BY,et al. Usefulness of dexmedetomidine during intracerebral aneurysm coiling[J]. J Korean Neurosurg Soc,2014,55(4):185-189.
[36] GOYAGI T,NISHIKAWA T,TOBE Y,et al. The combined neuroprotective effects of lidocaine and dexmedetomidine after transient forebrain ischemia in rats[J]. Acta Anaesthesiol Scand,2009,53(19):1176-1183.