可乐定对CO_2气腹时应激的影响

The effects of clonidine on the stress response of CO_2 pneumoperitoneum

目的 观察术前口服可乐定对CO2气腹时应激的调节作用。方法 选择无心血管和内分泌系统等合并症,择期腹腔镜胆囊切除术病人22例,随机分为两组,可乐定组(A)和对照组(B),每组11例。可乐定组病人在麻醉前90分钟口服可乐定5μg·kg-1,其余用药两组均同。气管插管静吸复合全身麻醉。记录麻醉前90分钟(T1)、诱导前即刻(T2)、气腹前即刻(T3)、气腹压达14mmHg时(T4)、气腹压平衡(达14mmHg)后5分钟(T5)各时点心率(HR)、平均动脉压(MAP);并于T1、T3及T5各时点自上肢静脉留置针抽取血标本,测定血糖(Glu)、皮质醇(Cor)、内皮素(ET)、一氧化氮(NO)。结果(1)HR、MAP:可乐定组在气腹压平衡后5分钟较气腹前(T3)HR、MAP均有显著升高(P<0.01),但与麻醉前90分钟相比,无显著差异(P>0.05)。可乐定组在麻醉期间HR、MAP维持一相对稳定的水平。对照组在气腹时HR、MAP均较可乐定组上升显著。(2)内分泌激素及血糖、血糖、皮质醇;可乐定组T5时血糖和皮质醇显著高于T3和T1(P<0.01),但均明显低于对照组(P<0.01)。Et:气腹后5分钟(T5)两组均上升明显(P<0.01),而可乐定组明显低于对照组(P<0.01)。NO:可乐定组T5较T1显著升高(P<0.05),而对照组T5明显低于T1(P<0.05)。NO／ET:可乐定组各时点变化不显著,对照组有明显下降趋势。

Objective To investigate the effects of clonidine on the stress response of CO2 pneumo-peritonneum. Methods 22 patients aged 25-45yr, ASA I, without endoctrine disorder and cardiovascular disease, scheduled for selective laparoscopic cholecystecomy were randomly into two groups. The HR and MAP were recorded at the following times: 90min before induction(T1), instant before induction( T2 ), instant before pneumoperitoneum ( T3 ), when the pressure of pneumoperitoneum reached 14mmHg(T4), 5min after the pressure of pneumoperitoneum reached 14mmHg(T5). Endo-thelin(E1), nitric oxide(NO), cortisol(Cor), glucose(Glu) invenous blood were measeured at T1 ,T3, T5. Results 1. The HR and MAP at T5 in group A increased significantly compared with T3(P< 0. 01), but showed no difference with T1 (P>0. 05) and showed significantly lower compared with those of group B(P<0. 01). 2. The blood glucose and serum cortisol concentration at T5 increased significantly compared with T3 and T1 (P<0. 01) in group A, but were lower compared with those of group B(P<0. 01). The plasma ET concentration at T5 in both groups increased significantly compared with T3, but was lower in group A(P<0. 01). In group A the serum NO concentration went higher at T5 compared with T1 (P<0. 05), while decreased significantly in group B. The ratio of NO/ ET showed no significant changes in group A during CO2 pneumopertitoneum(P>0. 05), while decreased significantly in group B. Conclusion Oral premedicatio with clonidine (5μg. kg-1) 90min before induction may help to provide perioperative hemodynamic stability and attenuate the stress response of carbon dioxide pneumopritoneum.