Seo Hyungseok, Ryu Ho-Geol, Son Je Do, Kim Jeong-Soo, Ha Eun Jin, Kim Jeong-Eun, Park Hee-Pyoung
Department of Anesthesiology and Pain Medicine, Dankook University Hospital, Cheonan Department of Anesthesiology and Pain Medicine Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Medicine (Baltimore). 2016 Dec;95(52):e5712. doi: 10.1097/MD.0000000000005712.
Dexmedetomidine, a selective α2-agonist, reduces cerebral blood flow and has neuroprotective effects against cerebral ischemia/reperfusion injury in experimental animals. We examined whether intraoperative dexmedetomidine would reduce the incidence of postoperative cerebral hyperperfusion syndrome (CHS) after superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis in patients with moyamoya disease.The electronic medical records of 117 moyamoya patients who underwent STA-MCA anastomosis were reviewed retrospectively. The patients were divided into 2 groups: 48 patients received intraoperative dexmedetomidine (Group D), while 69 patients did not (Group ND). The incidence (primary outcome), onset, and duration of postoperative CHS were noted.The incidence of postoperative CHS was 45.8% and 40.6% in groups D and ND, respectively (P = 0.708). The duration of postoperative CHS was shorter in group D than in group ND (median [Q1-Q3], 5 [3-7] vs 8 [5-10] days, P = 0.021). There was no significant difference in the onset of CHS between group D and group ND (0 [0-2] vs 1 [0-3] days, P = 0.226).In conclusion, intraoperative dexmedetomidine did not reduce the incidence of postoperative CHS, although it reduced the duration of CHS, in patients who had undergone direct revascularization surgery for moyamoya disease.
右美托咪定是一种选择性α2受体激动剂，可减少脑血流量，并对实验动物的脑缺血/再灌注损伤具有神经保护作用。我们研究了术中使用右美托咪定是否会降低烟雾病患者颞浅动脉-大脑中动脉（STA-MCA）吻合术后发生脑过度灌注综合征（CHS）的发生率。回顾性分析了117例行STA-MCA吻合术的烟雾病患者的电子病历。患者分为2组：48例患者术中使用右美托咪定（D组），69例患者未使用（ND组）。记录术后CHS的发生率（主要结局）、发作时间和持续时间。D组和ND组术后CHS的发生率分别为45.8%和40.6%（P = 0.708）。D组术后CHS的持续时间短于ND组（中位数[四分位间距]，5[3-7]天对8[5-10]天，P = 0.021）。D组和ND组CHS的发作时间无显著差异（0[0-2]天对1[0-3]天，P = 0.226）。总之，对于接受烟雾病直接血运重建手术的患者，术中使用右美托咪定虽可缩短CHS的持续时间，但并未降低术后CHS的发生率。
