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    右美托咪定在神经外科手术围术期应用的研究进展

    Research progress on the application of dexmedetomidine during the perioperative period of neurosurgery

    • 摘要: 右美托咪定是一种高选择性α2-肾上腺素能受体激动剂,通过激活蓝斑核及脊髓α2-肾上腺素能受体,介导协同的镇静-镇痛机制,能够有效降低围术期的交感神经兴奋性,维持血流动力学的稳定。右美托咪定的多重药理学特性在神经外科围术期麻醉管理中体现出显著优势,术前有效缓解患者焦虑情绪,并增强局部麻醉药物的效能,术中通过抑制手术创伤所引发的炎症级联反应及氧化应激损伤,减少继发性脑损伤的发生,有助于降低阿片类及全身麻醉药物的使用,术后有效预防苏醒期的躁动、谵妄以及认知功能障碍。右美托咪定通过诱导一种“可唤醒镇静”状态,为术中神经电生理监测及功能区唤醒手术提供了独特的麻醉镇静条件,使其成为功能神经外科理想的镇静药物。本文系统综述了右美托咪定在神经外科围术期应用的基础和临床研究进展,以期为优化神经外科手术围术期麻醉策略提供理论依据。

       

      Abstract: Dexmedetomidine is a highly selective α2-adrenergic receptor agonist that mediates a synergistic sedative-analgesic mechanism by activating the locus coeruleus and spinal α2-adrenergic receptors. It effectively reduces sympathetic nervous system excitability during the perioperative period, maintaining hemodynamic stability. The multiple pharmacological properties of dexmedetomidine demonstrate significant advantages in neurosurgical perioperative anesthesia management. Preoperatively, it effectively alleviates patient anxiety and enhances the efficacy of local anesthetics. Intraoperatively, it reduces secondary brain injury by inhibiting the inflammatory cascade and oxidative stress response induced by surgical trauma, and it helps decrease the use of opioids and general anesthetics. Postoperatively, dexmedetomidine effectively prevents agitation, delirium, and cognitive dysfunction during the recovery phase. By inducing a "wakeable sedation" state, it provides unique anesthetic and sedative conditions for intraoperative neurophysiological monitoring and awake functional area surgery, making it an ideal sedative for functional neurosurgery. This review systematically summarizes the basic and clinical research progress of dexmedetomidine in neurosurgical perioperative applications, aiming to provide a theoretical basis for optimizing perioperative anesthesia strategies in neurosurgery.

       

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