Application Of Dexmedetomidine In Anesthesia For Senile Hypertensive Intracerebral Hemorrhage Surgery

Objective:At the end of 2017,the country’s population over the age of 60 had reached 240 million.In 2012,the prevalence of hypertension among the elderly in my country was close to 54.9%.Hypertension is an important cause and risk factor for a variety of heart and cerebrovascular diseases.It affects the structure and function of important organs,such as the heart,brain and kidney,and ultimately leads to the failure of these organs.It is still the main cause of death from cardiovascular diseases.One.Hypertensive cerebral hemorrhage is the most common cause of non-traumatic intracranial hemorrhage.It has the characteristics of rapid onset,rapid change,high disability and mortality.It often occurs in middle-aged and elderly people,slightly more men,and it is easy to develop in winter and spring.Surgical removal of intracranial hematoma is one of the effective treatment methods.In emergency craniocerebral surgery,large bleeding,abnormal coagulation function,and large circulatory fluctuations are important risk factors for recurrence of cerebral hemorrhage and poor prognosis after surgery.Dexmedetomidine(Dex)can inhibit the excitement of central and peripheral sympathetic nerves,reduce stress response,inhibit the body’s inflammatory response,has sedative hypnosis,analgesia,and synergy with anesthetic drugs.In this study,Dexmedetomidine(Dex)was applied to elderly patients with hypertensive intracerebral hemorrhage during surgery.The main observation index is the changes in hemodynamics during surgery.The secondary observation indicators are intraoperative blood loss,operation time,and total amount of intraoperative anesthetics(propofol)and vasoactive drugs(urapidil).Method:Sixty-six patients with hypertensive cerebral hemorrhage who were hospitalized in the Department of Neurosurgery of Shenzhen Baoan Central Hospital and were scheduled to undergo emergency surgery due to their condition were selected as the research objects.The patients were randomly assigned to the control(1)group or dexmedetomidine(2)group,33 cases were selected as experimental subjects in each group.In the dexmedetomidine(2)group,dexmedetomidine(DEX)was formulated into a solution with a concentration of 4 μg/ml,and a load of 0.5 μg/kg was given 10 minutes before general anesthesia induction,and intravenous constant-rate pump injection for 10 minutes.During the operation,the pump was maintained at0.3μg/kg/h until the respiratory recovery(T5);the control group(1)was given an intravenous pump of equal volume normal saline at the same time period.Vasoactive drugs are given according to the situation during the operation,the blood pressure fluctuation range during the operation is kept within 20% of the basic value,and the heart rate is maintained at 50-120 beats/min.MAIN OUTCOME MEASURES:Hemodynamics of the two groups of subjects when entering the room(T0),after induction(T1),after tracheal intubation(T2),at the beginning of surgery(T3),after surgery(T4),and when breathing is restored(T5)Scientific indicators,including systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),heart rate(HR)and pulse oxygen saturation(SPO2).The operation time,intraoperative blood loss,and the dosage of vasoactive drugs(urapidil)and anesthetics(propofol)in the two groups were recorded.SPSS 13.0 statistical software was used for data analysis and processing.The measurement data is first evaluated for normality,and the measurement data conforming to the normal distribution are expressed as the mean ± standard deviation(),and the independent sample t test is used for the comparison between groups.The chi-square test was used to compare the enumeration data between groups.P<0.05 indicates that the difference is statistically significant.Result:1.There was no statistical difference in the general conditions(gender,age,BMI,GCS score)of the two groups of study subjects before surgery(P>0.05).2.There was no statistical difference in monitoring indicators SBP,DBP,MAP,HR,SPO2 between the two groups of subjects when they entered the operating room(T0)(P>0.05),after induction(T1),after tracheal intubation(T2),and the beginning of surgery There were statistically significant differences in hemodynamic indexes(MAP,HR,SBP,DBP)at time(T3),after operation(T4),and breathing recovery(T5)(P<0.05).There was no statistical difference in SPO2 values between the two groups of subjects at different times(T0,T1,T2,T3,T4,T5)during the operation(P>0.05).3.The use of anesthetic drugs(propofol)and vasoactive drugs(urapidil)in the dexmedetomidine(2)group was less than that in the control(1)group,which was statistically significant(P<0.01).4.Compared with the control group(1),the operation time of dexmedetomidine(2)group had no statistical difference(P>0.05).The intraoperative blood loss in the dexmedetomidine(2)group was significantly less than that in the control(1)group,and there was a statistical difference(P<0.01).Conclusion:The application of dexmedetomidine in the operation of elderly hypertensive cerebral hemorrhage can make the hemodynamic indexes(SBP,DBP,MAP,HR)more stable and reduce the occurrence of intraoperative hypertension.The use of dexmedetomidine has no significant effect on intraoperative pulse oxygen saturation(SPO2).Dexmedetomidine has no difference in the operation time,reduces the amount of intraoperative blood loss,and reduces the use of anesthetics(propofol)and vasoactive drugs(urapidil).