切换至 "中华医学电子期刊资源库"
高级检索
中华脑科疾病与康复杂志(电子版)

中华脑科疾病与康复杂志(电子版) ›› 2025, Vol. 15 ›› Issue (05) : 288 -292. doi: 10.3877/cma.j.issn.2095-123X.2025.05.006

临床研究

右美托咪定对慢性硬脑膜下血肿手术的效果研究
牛菲菲1, 郑全乐2,†(), 张亭亭2, 张同乐2, 李学天2, 杨文启2   
  1. 1065000　河北廊坊，爱德堡医院药剂科
    2065000　河北廊坊，爱德堡医院神经外科
  • 收稿日期:2025-01-10 出版日期:2025-10-15
  • 通信作者: 郑全乐

Study on the effects of dexmedetomidine in surgery for chronic subdural hematoma

Feifei Niu1, Quanle Zheng2,†(), Tingting Zhang2, Tongle Zhang2, Xuetian Li2, Wenqi Yang2   

  1. 1Department of Pharmacy, Aidebao Hospital, Langfang 065000, China
    2Department of Neurosurgery, Aidebao Hospital, Langfang 065000, China
  • Received:2025-01-10 Published:2025-10-15
  • Corresponding author: Quanle Zheng
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

牛菲菲, 郑全乐, 张亭亭, 张同乐, 李学天, 杨文启. 右美托咪定对慢性硬脑膜下血肿手术的效果研究[J/OL]. 中华脑科疾病与康复杂志(电子版), 2025, 15(05): 288-292.

Feifei Niu, Quanle Zheng, Tingting Zhang, Tongle Zhang, Xuetian Li, Wenqi Yang. Study on the effects of dexmedetomidine in surgery for chronic subdural hematoma[J/OL]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2025, 15(05): 288-292.

目的

探讨右美托咪定对慢性硬脑膜下血肿（CSDH）手术治疗患者术中血流动力学及术后疼痛的影响。

方法

选取廊坊爱德堡医院神经外科自2020年10月至2022年10月行手术治疗的96例CSDH患者为研究对象，采用随机数字表法分为对照组和研究组，每组48例。对照组患者给予单纯局部麻醉，研究组患者给予右美托咪定复合局部麻醉。比较2组患者切皮时（T1）、钻孔时（T2）、缝皮时（T3）及手术结束时（T4）的平均动脉压（MAP）、心率变化，以及术后3、12、24、48和72 h的疼痛情况和镇痛强度。

结果

研究组患者在T1、T2、T3及T4不同时间点的MAP、心率均较对照组高，差异有统计学意义（P<0.05）。在术后3、12、24、48和72 h，研究组患者视觉模拟评分（VAS）均低于对照组，差异有统计学意义（P<0.05）。术后12、24、48和72 h，研究组患者Ramsay评分均高于对照组，差异有统计学意义（P<0.05）。研究组患者麻醉期间不良反应发生率低于对照组，差异有统计学意义（P<0.05）。

结论

右美托咪定应用于CSDH手术治疗患者中麻醉效果较好，有助于维持术中血流动力学稳定，增强镇痛镇静效果，减少不良反应。

关键词: 右美托咪定, 慢性硬脑膜下血肿, 手术, 血流动力学, 疼痛
Objective

To investigate the impacts of Dexmedetomidine on intraoperative hemodynamics and postoperative pain in patients with chronic subdural hematoma (CSDH) undergoing surgical treatment.

Methods

A total of 96 patients undergoing surgery for CSDH admitted to the Neurosurgery Department of Langfang Aidebao Hospital from October 2020 to October 2022 were selected as the research subjects. They were randomly separated into a control group and a study group using a random number table method, with 48 patients in each group. The control group were given simple local anesthesia, while the study group were given Dexmedetomidine combined local anesthesia. The changes of mean arterial pressure (MAP) and heart rate at the time of skin incision (T1), drilling (T2), skin suture (T3), and the end of surgery (T4), and the pain and analgesia intensity at 3, 12, 24, 48, and 72 h after surgery were compared between the two groups.

Results

The MAP and heart rate of patients in the study group were significantly higher than those in the control group at time points T1, T2, T3, and T4 (P<0.05); at 3, 12, 24, 48 and 72 h after surgery, the visual analogue scale (VAS) of the study group was lower than that of the control group (P<0.05); at 12, 24, 48, and 72 h after surgery, the Ramsay scores of patients in the study group were higher than those in the control group (P<0.05); the incidence of adverse reactions during anesthesia in the study group was lower than that in the control group (P<0.05).

Conclusions

Dexmedetomidine has a good anesthetic effect in patients undergoing surgical treatment for CSDH. It can help maintain hemodynamic stability during surgery, enhance analgesic and sedative effects, and reduce adverse reactions.

Key words: Dexmedetomidine, Chronic subdural hematoma, Surgery, Hemodynamics, Pain
表1 2组CSDH患者的一般资料比较
Tabl.1 Comparison of general information between two groups of CSDH patients
组别 例数 性别（男/女，例） 年龄（岁，mean±SD） BMI（kg/m2，mean±SD）
对照组 48 21/27 45.32±9.66 23.67±2.55
研究组 48 23/25 45.94±10.12 23.91±2.36
χ2/t值   0.091 -0.307 -0.479
P值   0.763 0.760 0.633
表2 2组CSDH患者不同时间点MAP和心率比较（mean±SD）
Tab.2 Comparison of MAP and heart rate between two groups of CSDH patients at different time points (mean±SD)
项目 组别 例数 T0 T1 T2 T3 T4 F值 P值
MAP（mmHg） 研究组 48 98.72±10.76 94.02±9.91 90.47±9.58 91.16±9.82 93.38±9.66 4.315 0.002
对照组 48 98.29±10.82 84.53±9.07 80.22±8.62 82.41±8.57 84.16±8.62 28.880 <0.001
t值   0.192 4.924 5.583 4.711 5.032    
P值   0.849 <0.001 <0.001 <0.001 <0.001    
心率（次/min） 研究组 48 77.18±8.02 74.71±8.15 73.35±8.07 70.14±7.64 70.32±7.57 23.350 <0.001
对照组 48 76.62±8.14 70.12±7.79 68.28±7.92 66.36±7.05 67.21±6.95 14.060 <0.001
t值   0.342 2.921 3.244 2.492 2.124    
P值   0.734 0.004 0.002 0.015 0.037    
表3 2组CSDH患者术后不同时间点VAS及Ramsay评分比较（分，mean±SD）
Tab.3 Comparison of VAS and Ramsay scores between two groups of CSDH patients at different postoperative time points (score, mean±SD）
项目 组别 例数 术后3 h 术后12 h 术后24 h 术后48 h 术后72 h
VAS评分 研究组 48 3.19±0.52 3.66±0.47 4.14±0.61 4.75±0.77 3.47±0.61
对照组 48 4.01±0.86 4.97±0.92 5.45±0.98 6.16±1.04 5.46±0.84
t值   5.621 8.642 7.824 7.512 13.281
P值   <0.001 <0.001 <0.001 <0.001 <0.001
Ramsay评分 研究组 48 4.02±0.49 3.99±0.45 4.96±0.64 5.02±0.71 3.77±0.54
对照组 48 3.97±0.43 3.76±0.41 4.26±0.56 4.27±0.55 3.52±0.46
t值   0.532 2.624 5.831 5.744 2.382
P值   0.597 0.010 <0.001 <0.001 0.019
表4 2组CSDH患者的不良反应发生情况比较[例（%）]
Tab.4 Comparison of adverse reactions between the two groups of CSDH patients [n(%)]
组别 例数 躁动 心动过速 心动过缓 呛咳 总计
研究组 48 1（2.08） 2（4.17） 1（2.08） 1（2.08） 5（10.42）
对照组 48 3（6.25） 3（6.25） 5（10.42） 2（4.17） 13（27.08）
χ2值           4.376
P值           0.036
[1]
Jindal G, Sharafaddin-Zadeh Y, Bukhari O, et al. Complications of middle meningeal artery embolization for chronic subdural hematoma: a systematic literature review[J]. Can J Neurol Sci, 2025, 1-11. Online ahead of print. DOI: 10.1017/cjn.2025.10369.
[2]
Perini Durigan Á, de Paula Simoni M, Braga N, et al. Evolution of surgery for chronic subdural hematoma: a narrative review[J]. Ann Med Surg (Lond), 2025, 87(7): 4139-4144. DOI: 10.1097/ms9.0000000000003324.
[3]
Sahyouni R, Goshtasbi K, Mahmoodi A, et al. Chronic subdural hematoma: a historical and clinical perspective[J]. World Neurosurg, 2017, 108: 948-953. DOI: 10.1016/j.wneu.2017.09.064.
[4]
郑彬,张顺才,索琨,等.右美托咪定对创伤性脑损伤大鼠认知功能和海马炎性反应的影响[J].中华脑科疾病与康复杂志(电子版), 2015, 5(6): 411-415. DOI: 10.3877/cma.j.issn.2095-123X.2015.06.009.
[5]
Negm EM, Younus MA, Morsy AA, et al. Opioid-sparing multimodal analgesia for post-craniotomy pain: a randomized, double-blind, placebo-controlled trial[J]. BMC Anesthesiol, 2025, 25(1): 437. DOI: 10.1186/s12871-025-03306-5.
[6]
Stachtari C, Stergiouda Z, Koraki E, et al. Dexmedetomidine as an adjuvant to scalp block in patients undergoing elective craniotomy: a prospective randomized controlled trial[J]. Clin Neurol Neurosurg, 2023, 227: 107669. DOI: 10.1016/j.clineuro.2023.107669.
[7]
Havryliv T, Devinyak O, Yartym O, et al. Single-center comparison of chronic subdural hematoma evacuation outcomes under local versus general anesthesia[J]. World Neurosurg, 2024, 184: e39-e44. DOI: 10.1016/j.wneu.2023.12.116.
[8]
Surve RM, Bansal S, Reddy M, et al. Use of dexmedetomidine along with local infiltration versus general anesthesia for burr hole and evacuation of chronic subdural hematoma (CSDH)[J]. J Neurosurg Anesthesiol, 2017, 29(3): 274-280. DOI: 10.1097/ANA.0000000000000305.
[9]
Karim HMR. Dexmedetomidine versus propofol along with scalp block for chronic subdural haematoma evacuation under monitored anaesthesia care: which is better?[J]. Turk J Anaesthesiol Reanim, 2019, 47(1): 79-80. DOI: 10.5152/TJAR.2018.13914.
[10]
Zhang Z, Ferretti V, Güntan İ, et al. Neuronal ensembles sufficient for recovery sleep and the sedative actions of α2 adrenergic agonists[J]. Nat Neurosci, 2015, 18(4): 553-561. DOI: 10.1038/nn.3957.
[11]
Chandar Chinnarasan V, Bidkar PU, Swaminathan S, et al. Comparison of dexmedetomidine versus fentanyl-based total intravenous anesthesia technique on the requirement of propofol, brain relaxation, intracranial pressure, neuronal injury, and hemodynamic parameters in patients with acute traumatic subdural hematoma undergoing emergency craniotomy: A randomized controlled trial[J]. Surg Neurol Int, 2024, 15: 462. DOI: 10.25259/SNI_892_2024.
[12]
Lewis SR, Nicholson A, Smith AF, et al. Alpha-2 adrenergic agonists for the prevention of shivering following general anaesthesia[J]. Cochrane Database Syst Rev, 2015, 2015(8): CD011107. DOI: 10.1002/14651858.CD011107.pub2.
[13]
Lim YP, Yahya N, Izaham A, et al. The comparison between propofol and dexmedetomidine infusion on perioperative anxiety during regional anesthesia[J]. Turk J Med Sci, 2018, 48(6): 1219-1227. DOI: 10.3906/sag-1802-126.
[14]
Liu J, Gao R, Ma J, et al. Pulmonary protective and antiinflammatory effects of dexmedetomidine in cardiac surgery with cardiopulmonary bypass: a systematic review and metaanalysis [J]. BMC Anesthesiol, 2025, 25(1): 414. DOI: 10.1186/s12871-025-03286-6.
[15]
Srivastava VK, Agrawal S, Kumar S, et al. Comparative evaluation of dexmedetomidine and propofol along with scalp block on haemodynamic and postoperative recovery for chronic subdural haematoma evacuation under monitored anaesthesia care[J]. Turk J Anaesthesiol Reanim, 2018, 46(1): 51-56. DOI: 10.5152/TJAR.2018.16878.
[16]
Fotiadis P, McKinstry-Wu AR, Weinstein SM, et al. Changes in brain connectivity and neurovascular dynamics during dexmedetomidine-induced loss of consciousness[J]. Commun Biol, 2025, 8(1): 1254. DOI: 10.1038/s42003-025-08577-9.
[17]
Xu XP, Liu C, Wu Q. Monitored anesthesia care with dexmedetomidine for chronic subdural hematoma surgery[J]. J Neurosurg Anesthesiol, 2014, 26(4): 408-409. DOI: 10.1097/ANA.0000000000000034.
[18]
Belrose JC, Noppens RR. Anesthesiology and cognitive impairment: a narrative review of current clinical literature[J]. BMC Anesthesiol, 2019, 19(1): 241. DOI: 10.1186/s12871-019-0903-7.
[19]
Ishikawa M, Sakamoto A. Postoperative desaturation and bradypnea after general anesthesia in non-ICU patients: a retrospective evaluation[J]. J Clin Monit Comput, 2020, 34(1): 81-87. DOI: 10.1007/s10877-019-00293-0.
[1] 杨浩, 王春岭, 席少华, 尹素然. 富血小板血浆联合关节镜手术治疗膝骨关节炎的疗效分析[J/OL]. 中华损伤与修复杂志(电子版), 2025, 20(06): 499-504.
[2] 北京人体损伤修复研究会创面规范化治疗专家共识组. 创面换药疼痛控制专家共识[J/OL]. 中华损伤与修复杂志(电子版), 2025, 20(06): 467-475.
[3] 高加勒, 张忠涛. 结直肠癌外科领域最新进展与热点[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(06): 595-599.
[4] 张建锋, 田若曦, 李保坤, 马洪庆, 胡旭华, 曹龙飞, 王贵英. 我国腹腔镜右半结肠癌的手术难点及对策[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(06): 605-608.
[5] 周丽君, 李姣姣, 孙燕, 王露, 钱蓉. 不同吻合方式对腹腔镜辅助远端胃癌根治术患者术后恢复的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(06): 642-645.
[6] 王毅, 孔剑桥, 张鹏, 代扬, 李恒平. 腹腔镜超声引导十二指肠镜治疗胆囊合并胆总管结石[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(06): 658-661.
[7] 马超, 王传嘉, 张武坊. 经腋窝入路单孔腔镜保乳术与传统开放手术治疗早期乳腺癌的对比研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(06): 674-677.
[8] 张超, 常剑. 混合入路与中间入路行腹腔镜右半结肠癌根治术的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(06): 685-688.
[9] 蒲茜, 文曰, 卢春燕, 赵锐. 经肛门内镜微创手术治疗直肠肿瘤应用研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(06): 698-700.
[10] 贺雅莉, 黄丽, 杨培娟. 功能保留手术在低位直肠癌治疗中的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(06): 701-704.
[11] 王伟全, 屈祥富, 周智. 手术治疗胆总管异物一例[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(06): 711-712.
[12] 程必盛, 吴芃. 2025EAU年会要点：微创、远程与精准泌尿外科的发展趋势[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(06): 693-699.
[13] 宋小飞, 巫嘉文, 孙阳. 后腹腔镜上尿路手术中良性大体积标本体内分块取出技术的应用研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(06): 720-726.
[14] 中华医学会外科学分会外科手术学学组. 倡用图文外科手术记录专家共识（2025版）[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(06): 805-812.
[15] 董艳, 郭继武, 毛杰. 儿童重症急性胰腺炎一例诊治分析并文献复习[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(06): 956-961.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号

AI
小
编
AI小编
你好！我是《中华医学电子期刊资源库》AI小编，有什么可以帮您的吗？