右美托咪定对腹腔镜手术围术期血儿茶酚胺及血流动力学的影响

Effect of Dexrnedetomidine on the Level of Catecholamines and Hemodynamics in Patients Undergoing Laparoscopy

目的探讨右美托咪定对腹腔镜手术患者围术期血儿茶酚胺及血流动力学的影响。方法 40例ASA为Ⅰ~Ⅱ级择期静吸复合全麻下行妇科腹腔镜卵巢肿瘤切除术,按就诊顺序编号,随机数字表随机分为右美托咪定组（D组,n=20）和对照组（C组,n=20）。所有患者均不用术前药,D组在麻醉诱导插管前5 min静脉注射右美托咪定0.5μg/kg,继以0.4μg.kg-1.h-1持续泵注,C组静脉注射等容量的生理盐水。连接BioZ.com数字化无创血流动力学监测系统连续监测血流动力学变化,分别于麻醉前（T1）,气管插管后1 min（T2）,气腹后5 min（T3）,气腹后15 min（T4）,气腹后30 min（T5）,解除气腹后5 min（T6）各时点,记录心率（heart rate,HR）、平均动脉压（mean arterial pressure,MAP）、心排血量（cardiac output,CO）、体循环阻力（systemic vascular resistance,SVR）、加速指数（acceleration index,ACI）、胸腔液体量（thoracic fluid content,TFC）。同时检测2组患者麻醉前（T1）、气腹后30 min（T5）和解除气腹后5 min（T6）肾上腺素和去甲肾上腺素水平。结果 D组肾上腺素和去甲肾上腺素水平T5和T6时点变化不明显,与麻醉前差异无显著性（P〉0.05）;C组对应上述时点肾上腺素和去甲肾上腺素水平较麻醉前明显升高（P〈0.05）,与D组比较差异有显著性（P〈0.05）。D组MAP、CO、SVR、ACI、TFC在各时点变化不明显（P〉0.05）,HR随着用药时间的延长明显变慢（P〈0.05）,但无临床意义;C组HR、MAP、SVR于T2、T3升高最显著（P〈0.05）,CO T2、T3时点显著降低（P〈0.05）。D组术中应用麻黄碱和阿托品例数多于C组,但无统计学差异（2例vs.0例,P=0.487;3例vs.0例,P=0.231）,D组术后诉切口疼痛例数明显少于C组（P=0.001）。结论腹腔镜全麻手术辅助应用右美托咪定能显著减轻麻醉插管及CO2气腹时的应激反应,抑制肾上腺素及去甲肾上腺素等儿茶酚胺物质释放,维持血流动力学的稳定。

Objective To evaluate the effect of dexmedetomidine（Dex） on the concentration of catecholamines and hemodynamics in patients undergoing laparoscopy. Methods Totally 40 patients（ASA grade Ⅰ-Ⅱ） undergoing selective laparoscopic resection of ovarian tumors under general anesthesia were enrolled in this study.The patients were randomly divided into Dex group（n=20） and control group（n=20）.None of the groups received pre-operative meditation.In Dex group,the patients received intravenous injection of Dex（0.5 μg/kg） 5 minutes before intubation,and then received continuous injection of Dex at a rate of 0.4 μg·kg-1·h-1 during the operation;while in the control group,physiological saline was used instead of Dex.BioZ.com system was employed to monitor the hemodynamics of the patients during the procedure.HR,MAP,CO,SVR,ACI and TFC were determined before anesthesia（T1）,1 minute after intubation（T2）,5,15,and 30 minutes after pneumoperitoneum（T3-T5）,and 5 minutes after de-pneumoperitoneum（T6）.Meanwhile,the levels of adrenaline and norepinephrine were determined at T1,T5,and T6 in both the groups.Results In Dex group,the levels of adrenaline and norepinephrine at T5 and T6 were not changed significantly compared to T1（P0.05）;whereas,in the control group,the levels were increased significantly at T5 and T6（P0.05）,and were significantly higher than those in Dex group at the same time points（P0.05）.In Dex group,MAP,CO,SVR,ACI and TFC were not changed significantly at different time points.HR was decreased with time of medication（P0.05）,but showed no clinical significance.In the control group,HR,MAP and SVR reached peaks at T2 or T3（P0.05）,when CO decreased to the bottom（P0.05）.Two patients from the Dex group received ephedrine and three received atropine,while none of the control group were prescribed the drugs（P=0.487,P=0.231）.The number of patients who complained of postoperative insional pain in the Dex group was significantly less than that in the control（P=0.001）. Conclusion During laparoscopy under general anesthesia,Dex can inhibit the stress reaction at intubation and CO2 pneumoperitoneum,reduce the level of catecholamine（E and NE） and thus stabilize hemodynamics.