摘要： 目的  研究右美托咪啶在烟雾病颞肌贴敷术中的应用，探讨其脑保护作用机制。方法 共60 例患者随机分为右美托咪啶组和生理盐水对照组（对照组），麻醉诱导前和术中分别予不同剂量右美托咪啶［0.60 μg/kg、0.40 μg/（kg·h）］和等量生理盐水，并以丙泊酚和瑞芬太尼维持麻醉，间断静脉注射顺式苯磺酸阿曲库铵；记录给药前（T₀）、气管插管前（T₁）、气管插管后1 min（T₂）、切开皮肤时（T₃）、拔除气管插管前（T₄）、拔除气管插管后1 min（T₅）时的心率、平均动脉压和麻醉药物剂量，以及麻醉复苏情况和并发症发生率，比较两组患者外周血谷氨酰胺和丙二醛表达水平。结果 与T0时相比，右美托咪啶组患者T_{2 ~ 4}心率和平均动脉压均降低（P < 0.05）；与对照组相比，右美托咪啶组患者术中丙泊酚和瑞芬太尼剂量减少（均P < 0.05），意识恢复时间和拔除气管插管时间缩短（均P = 0.000）；且无一例出现躁动、呛咳和术后寒战等不良反应（均P < 0.05）。两组患者外周血谷氨酰胺和丙二醛水平均显著升高（P <0.05），但对照组高于右美托咪啶组（均P < 0.05）。结论 全凭静脉麻醉下行颞肌贴敷术治疗烟雾病，术中复合应用右美托咪啶可维持围麻醉期更平稳的血流动力学状态，减少麻醉药物剂量，术后麻醉复苏快、平稳，同时通过减少兴奋性神经递质的释放而发挥脑保护作用。

关键词: 右美托咪啶, 脑底异常血管网病, 颞肌, 神经外科手术

Abstract: Objective   To study the application of dexmedetomidine in patients undergoing temporal muscle sticking for moyamoya disease (MMD), and to discuss the possible mechanism of brain protection. Methods  Sixty patients undergoing temporal muscle sticking operation were randomly divided into 2 groups: dexmedetomidine group (Group D, N = 30) and control group (Group S, N = 30), respectively receiving dexmedetomidine intravenous infusion (0.60 μ g/kg) and the same dose of normal saline before anesthesia induction. In Group D, dexemdetomidine was administered continuously (intravenous pumping) with the dose of 0.40 μg/(kg·h) perioperatively, while the same dose of normal saline was administered in Group S. Heart rate (HR) and mean arterial pressure (MAP) were recorded at T₀ (before administration), T₁ (before tracheal intubation), T₂ (1 min after intubation), T₃ (at the moment of skin incision), T₄ (before extubation) and T₅ (1 min after extubation) respectively. Total amount of propofol, remifentanil and patients' recovery conditions after anesthesia were also recorded. Glutamine and malondialdehyde (MDA) were measured and compared before and after operation. Results  In group D, HR and MAP decreased significantly at T_2-4 compared with T₀ (P < 0.05, for all). Total amount of propofol, remifentanil in Group D was lower than that in Group S (P < 0.05, for all) and the patients' recovery conditions in Group D after anesthesia was better than Group S (P = 0.000, for all), without occurence of shivering, cough and dysphoria (P < 0.05, for all). Glutamine and MDA increased after anesthesia compared with that before anesthesia in both 2 groups (P < 0.05, for all), however, it was higher in Group S than that in Group D (P < 0.05, for all). Conclusions  Dexmedetomidine can provide stable hemodynamic condition during the anesthesia with patients undergoing temporal muscle sticking for moyamoya disease, and has a positive effect on improving both the outcome of the operation and recovery conditions. Also it can provide brain protection effect by decreasing the level of excitatory amino acids.

Key words: Dexmedetomidine, Moyamoya disease, Temporal muscle, Neurosurgical procedures