2025 年第 9 期 第 20 卷

右美托咪定复合喉罩全身麻醉对急性前循环大血管闭塞取栓术患者脑氧供需平衡的影响

The effect of dexmedetomidine combined with laryngeal mask general anesthesia on cerebral oxygen supply and demand balance in patients undergoing acute anterior circulation large vessel occlusion thrombectomy

作者：麻陶霞吴继敏陈琴金林飞

英文作者：Ma Taoxia Wu Jimin Chen Qin Jin Linfei

单位：温州医科大学附属第六医院浙江省丽水市人民医院麻醉科，丽水323000

英文单位：Department of Anesthesiology the Sixth Affiliated Hospital of Wenzhou Medical University Lishui People′s Hospital Zhejiang Province Lishui 323000 China

关键词：急性前循环大血管闭塞取栓术；右美托咪定；喉罩全身麻醉；脑氧供需平衡

英文关键词：Acuteanteriorcirculationlargevesselocclusionthrombectomy;Dexmedetomidine;Laryngealmaskgeneralanesthesia;Cerebraloxygensupplyanddemandbalance

• 摘要：

• 目的 分析右美托咪定复合喉罩全身麻醉对急性前循环大血管闭塞取栓术患者脑氧供需平衡的影响。方法 纳入2022年12月至2024年12月于浙江省丽水市人民医院接受急性前循环大血管闭塞取栓术的患者95例，依据随机数字表法分为观察组（47例）和对照组（48例）。对照组实施喉罩全身麻醉，观察组在喉罩全身麻醉基础上手术开始时给予盐酸右美托咪定注射液静脉输注。比较2组术中临床指标［麻醉诱导前（T0）、麻醉诱导后（T1）、手术15 min（T2）、术毕（T3）的平均动脉压（MAP）、心率、脉搏血氧饱和度（SpO2）水平］，比较2组T0、T3、术后24 h（T4）的颈静脉球部血氧饱和度（SjvO2）、脑氧摄取率（CERO2）、动脉血氧含量（CaO2）、颈内静脉血氧含量（CjvO2），比较2组手术前后美国国立卫生研究院卒中量表（NIHSS）评分。结果 观察组穿刺到血管再通时间、取栓次数短于/少于对照组，首次再通率高于对照组（均P＜0.05）。2组患者T1、T2、T3的MAP、心率呈先降低后升高的趋势，但观察组T1、T2的MAP、心率均高于对照组（均P＜0.05）；2组患者SpO2无时间、组间、交互效应（均P＞0.05）。2组患者T0、T3、T4的SjvO2、CaO2、CjvO2均呈先降低后升高的趋势，CERO2呈先升高后降低的趋势，但观察组T3时点的SjvO2、CaO2、CjvO2均高于对照组、CERO2低于对照组（均P＜0.05）。术前观察组与对照组NIHSS评分比较差异无统计学意义［（17.2±2.6）分比（17.2±2.8）分］（t=0.145，P=0.885）；术后48 h 2组NIHSS评分均低于术前且观察组低于对照组［（9.6±1.2）分比（12.4±1.5）分］（t=10.208，P＜0.001）。结论 右美托咪定复合喉罩全身麻醉用于急性前循环大血管闭塞取栓术患者可改善术中临床指标，稳定血流动力学，平衡脑氧供需，减少神经功能损伤。

• Objective To analyze the effect of dexmedetomidine combined with laryngeal mask general anesthesia on cerebral oxygen supply and demand balance in patients undergoing acute anterior circulation large vessel occlusion thrombectomy. Methods A total of 95 patients who underwent acute anterior circulation large vessel occlusion thrombectomy in Lishui People′s Hospital, Zhejiang Province from December 2022 to December 2024 were included. According to the random number table method, they were divided into an observation group (47 cases) and a control group (48 cases). The control group received general anesthesia with laryngeal mask, while the observation group received intravenous infusion of dexmedetomidine hydrochloride injection at the beginning of the surgery on the basis of general anesthesia with laryngeal mask. The intraoperative clinical indexes of the two groups were compared, such as the mean arterial pressure(MAP), heart rate and pulse oxygen saturation(SpO2) levels of the two groups were recorded before anesthesia induction(T0), after anesthesia induction(T1), 15 min during surgery (T2) and after surgery(T3). The blood oxygen saturation(SjvO2), cerebral oxygen uptake rate(CERO2), arterial oxygen content(CaO2) and internal carotid vein oxygen content(CjvO2) of the two groups were compared at T0, T3 and 24 h after surgery(T4). The national institutes of health stroke scale (NIHSS) scores of the two groups before and after surgery were analyzed. Results The time from puncture to vascular recanalization and the number of thrombectomy in the observation group were shorter/less than those in the control group, and the first recanalization rate was higher than that in the control group (all P<0.05). The MAP and heart rate of T1, T2 and T3 in the two groups decreased first and then increased, but the MAP and heart rate of T1 and T2 in the observation group were higher than those in the control group (all P<0.05). There were no time, group and interaction effects on SpO2 of patients in the two groups (all P>0.05). The SjvO2, CaO2 and CjvO2 of T0, T3 and T4 in the two groups decreased first and then increased, and CERO2 increased first and then decreased, but the SjvO2, CaO2, and CjvO2 of T3 in the observation group were higher than those in the control group, and CERO2 was lower than that in the control group (all P<0.05). There was no significant difference in NIHSS score between the observation group and the control group before operation ［(17.2±2.6) vs (17.2±2.8)］(t=0.145, P=0.885). The NIHSS scores of the two groups at 48 h after operation were lower than those before operation, and the NIHSS scores of the observation group were lower than those of the control group ［(9.6±1.2) vs (12.4±1.5)］(t=10.208, P<0.001). Conclusion The combination of dexmedetomidine and laryngeal mask general anesthesia can improve intraoperative clinical indicators, stabilize hemodynamics, balance cerebral oxygen supply and demand, and reduce neurological damage in patients undergoing acute anterior circulation large vessel occlusion thrombectomy.