中国临床药理学杂志

右美托咪定联合瑞芬太尼神经阻滞在脑动脉瘤夹闭术患者中的临床研究

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李冰 ^a , 陈俊丞 ^a , 黄俊龙 ^b , 黎志华 ^a , 罗树宏 ^c , 黄秀莲 ^a , 陈莺 ^a

中国临床药理学杂志 | 临床与基础桥接研究 2025,41(24): 3451-3457

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中国临床药理学杂志 |临床与基础桥接研究 2025 , 41 (24) : 3451 -3457

右美托咪定联合瑞芬太尼神经阻滞在脑动脉瘤夹闭术患者中的临床研究

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李冰^a, 陈俊丞^a, 黄俊龙^b, 黎志华^a, 罗树宏^c, 黄秀莲^a, 陈莺^a

作者信息

^a.福建医科大学附属龙岩第一医院麻醉科，福建龙岩 364000

^b.福建医科大学附属龙岩第一医院神经外科，福建龙岩 364000

^c.福建医科大学附属龙岩第一医院药剂科，福建龙岩 364000

通讯作者:

陈莺，副主任医师，硕士生导师 MP: 13959480611 E-mail: chenying@fjmu.edu.cn

作者简介:

李冰（1987-），女，本科，主治医师，主要从事临床麻醉方面的工作和研究

Clinical trial on dexmedetomidine combined with remifentanil and scalp nerve block in patients undergoing craniotomy and aneurysm clipping

Bing LI^a, Jun-cheng CHEN^a, Jun-long HUANG^b, Zhi-hua LI^a, Shu-hong LUO^c, Xiu-lian HUANG^a, Ying CHEN^a

Affiliations

^a.Department of Anesthesiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, Fujian Province, China

^b.Department of Neurosurgery, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, Fujian Province, China

^c.Department of Pharmacy, Longyan First Affiliated Hospital of Fujian Medical University, Longyan 364000, Fujian Province, China

出版时间: 2025-12-28 doi: 10.13699/j.cnki.1001-6821.2025.24.001

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摘要

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目的

观察右美托咪定注射液联合瑞芬太尼注射液和头皮神经阻滞在开颅动脉瘤夹闭术患者的临床疗效及安全性。

方法

将接受开颅动脉瘤夹闭术患者根据随机数字法分为对照组和试验组。所有患者均采用统一方案进行麻醉诱导，并于诱导后行超声引导下头皮神经阻滞。麻醉维持阶段，2组均持续泵注瑞芬太尼注射液（0.1~0.2 μg·kg^-1·min^-1）和顺苯磺酸阿曲库铵注射液（0.2 mg·kg^-1·h^-1）及静脉泵注丙泊酚乳状注射液（3~8 mg·kg^-1·h^-1），试验组在对照组的基础上静脉泵注右美托咪定注射液（0.4 μg·kg^-1·min^-1）。比较2组患者的苏醒时间、拔管时间、血流动力学变化、镇痛及镇静评分、脑损伤及应急反应相关标志物，并进行安全性评价。

结果

本研究共入组110例，对照组和试验组各55例。对照组和试验组的苏醒时间分别为（19.73±3.52）和（17.87±2.69）min;拔管时间分别为（21.78±3.83）和（19.33±3.46）min；在插管后5 min（T1）时，平均动脉压（MAP）分别为（83.67±12.99）和（89.31±14.39）mmHg；神经阻滞时（T2）时，MAP分别为（81.40±13.92）和（86.58±12.18）mmHg；手术结束后10 min（T5）时，MAP分别为（83.56±12.58）和（89.02±13.48）mmHg；在T1时，心率（HR）分别为（65.55±11.39）和（72.42±11.66）beats·min^-1；T2时，HR分别为（63.65±13.54）和（70.15±12.29）beats·min^-1；神经阻滞后10 min（T3）时，HR分别为（64.65±14.26）和（71.13±12.49）beats·min^-1；锯颅骨时（T4）时，HR分别为（62.44±12.67）和（69.02±13.57）beats·min^-1；T5时，HR分别为（67.18±10.40）和（74.84±13.77）beats·min^-1；试验组的上述指标与对照组比较，在统计学上差异均有统计学意义（均P<0.05）。对照组和试验组的药物不良反应总发生率分别为30.91%（17例/55例）和14.55%（8例/55例），在统计学上差异有统计学意义（P<0.05）。

结论

右美托咪定注射液联合瑞芬太尼注射液、头皮神经阻滞在开颅动脉瘤夹闭术中具有较好的临床疗效且安全性好。

关键词

右美托咪定注射液 / 颅内动脉瘤 / 开颅手术 / 脑损伤 / 血流动力学 / 头皮神经阻滞

Abstract

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Objective

To observe the clinical efficacy and safety of dexmedetomidine injection combined with remifentanil injection and scalp nerve block in patients undergoing craniotomy for aneurysm clipping.

Methods

Patients who underwent craniotomy for aneurysm clipping were divided into control group and treatment group according to random number method . All patients were treated with a unified scheme for anesthesia induction, and ultrasound-guided scalp nerve block was performed after induction. During the anesthesia maintenance phase, remifentanil injection (0.1-0.2 μg·kg^-1·min^-1), atracurium besylate injection (0.2 mg·kg^-1·h^-1) and propofol emulsion injection (3-8 mg·kg^-1·h^-1) were continuously pumped into the two groups. And dexmedetomidine injection (0.4 μg·kg^-1·min^-1) was pumped into the treatment group on the basis of control group. The recovery time, extubation time, hemodynamic changes, analgesia and sedation scores, brain injury and emergency response related markers were compared between the two groups, and the safety was evaluated.

Results

A total of 110 cases were enrolled, including 55 in control group and 55 in treatment group. The recovery time of control group and treatment group were (19.73±3.52) and (17.87±2.69) min, respectively; and the extubation time were (21.78±3.83) and (19.33±3.46) min, respectively; the mean arterial pressure (MAP) at 5 minutes after intubation (T1) were (83.67±12.99) and (89.31±14.39) mmHg, respectively; and at nerve block (T2), the MAP were (81.40±13.92) and (86.58±12.18) mmHg, respectively; at 10 minutes after the operation (T5), the MAP were (83.56±12.58) and (89.02±13.48) mmHg, respectively; and the heart rate (HR) at T1 were (65.55±11.39) and (72.42±11.66) beats·min^-1, respectively; the HR at T2 were (63.65±13.54) and (70.15±12.29) beats·min^-1, respectively; at 10 minutes after nerve block (T3), the HR were (64.65±14.26) and (71.13±12.49) beats·min^-1, respectively; when sawing the skull (T4), the HR were (62.44±12.67) and (69.02±13.57) beats·min^-1, respectively; and at T5, the HR were (67.18±10.40) and (74.84±13.77) beats·min^-1, respectively. Compared with control group, the differences of the above indicators of treatment group were all statistically significant (all P<0.05). The total incidence of adverse drug reaction rates in control group and treatment group were 30.91% (17 cases /55 cases) and 14.55% (8 cases /55 cases), respectively, with statistically significant difference (P<0.05).

Conclusion

Dexmedetomidine injection combined with remifentanil injection and scalp nerve block has good clinical efficacy and safety in craniotomy and aneurysm clipping.

Key words

dextromethorphan injection / intracranial aneurysm / craniotomy / brain injury / hemodynamics / scalp nerve block

引用本文

李冰, 陈俊丞, 黄俊龙, 黎志华, 罗树宏, 黄秀莲, 陈莺. 右美托咪定联合瑞芬太尼神经阻滞在脑动脉瘤夹闭术患者中的临床研究. 中国临床药理学杂志, 2025 , 41 (24) : 3451 -3457 . DOI: 10.13699/j.cnki.1001-6821.2025.24.001

Bing LI, Jun-cheng CHEN, Jun-long HUANG, Zhi-hua LI, Shu-hong LUO, Xiu-lian HUANG, Ying CHEN. Clinical trial on dexmedetomidine combined with remifentanil and scalp nerve block in patients undergoing craniotomy and aneurysm clipping[J]. Chinese Journal of Clinical Pharmacology, 2025 , 41 (24) : 3451 -3457 . DOI: 10.13699/j.cnki.1001-6821.2025.24.001

基金

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福建省自然科学基金资助项目(2021J011438)

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2025年第41卷第24期

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doi: 10.13699/j.cnki.1001-6821.2025.24.001

接收时间：2025-05-20
首发时间：2026-08-05
出版时间：2025-12-28

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收稿日期：2025-05-20

基金

福建省自然科学基金资助项目(2021J011438)

作者信息

^a.福建医科大学附属龙岩第一医院麻醉科，福建龙岩 364000

^b.福建医科大学附属龙岩第一医院神经外科，福建龙岩 364000

^c.福建医科大学附属龙岩第一医院药剂科，福建龙岩 364000

通讯作者:

陈莺，副主任医师，硕士生导师 MP: 13959480611 E-mail: chenying@fjmu.edu.cn

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https://castjournals.cast.org.cn/joweb/zglcylxzz/CN/10.13699/j.cnki.1001-6821.2025.24.001

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2种不同金属材料的力学参数

科 Family	属数 Number of genus	种数 Number of species	占总种数比例 Percentage of total species (%)	属 Genus	种数 Number of species	占总种数比例 Percentage of total species (%)
鹅膏菌科Amanitaceae	2	11	5.26	鹅膏菌属 Amanita	10	4.78
小菇科 Mycenaceae	2	12	5.74	丝盖伞属 Inocybe	5	2.39
多孔菌科 Polyporaceae	8	14	6.70	蜡蘑属 Laccaria	5	2.39
红菇科 Russulaceae	3	23	11.00	小皮伞属 Marasmius	6	2.87
				小菇属 Mycena	11	5.26
				光柄菇属 Pluteus	5	2.39
				红菇属 Russula	17	8.13
				栓菌属 Trametes	5	2.39

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