右美托咪定对静吸复合麻醉患者围术期应激功能的影响

Effects of dexmedetomidine on the stress reaction of patients in perioperative period under intravenous-inhalation anesthesia

目的观察右美托咪定对静吸复合麻醉患者围术期应激功能的影响。方法选择择期接受静吸复合麻醉的患者80例,应用随机数字表随机分为右美托咪定组和对照组,每组40例。右美托咪定组术前静脉微泵给予负荷量右美托咪定1μg/kg,推注时间15 min,维持剂量为0.2μg/(kg.h),对照组术前静脉微泵给予0.9%生理盐水20 ml,推注时间15 min。芬太尼-异丙酚-罗库溴铵诱导,七氟醚-芬太尼-顺式阿曲库铵维持,术毕呼吸恢复后拔管。观察并记录患者入手术室时(T0),插管前即刻(T1),插管后即刻(T2)、插管后30 min(T3)、拔管后即刻(T4),拔管后30 min(T5)的动脉血压和心率记录,并在T0,T2,T3,T4各时点抽取静脉血标本,检测血糖、血浆皮质醇、肾上腺素、去甲肾上腺素浓度。结果右美托咪定组T3时点动脉血压较术前下降,差异有统计学意义(P<0.05);对照组T2和T4时点动脉血压,心率较术前上升,差异有统计学意义(P<0.05)。两组间T2,T3,T4时点动脉血压和心率间差异有统计学意义。右美托咪定组围手术期血糖较术前变化无统计学意义,T3时点血浆皮质醇、肾上腺素、去甲肾上腺素较术前下降,差异有统计学意义(P<0.05);对照组T2,T3,T4时点血糖、血浆皮质醇、肾上腺素、去甲肾上腺素较术前上升,差异有统计学意义(P<0.05),两组间T2,T3,T4时点血糖、血浆皮质醇、肾上腺素、去甲肾上腺素差异有统计学意义(P<0.05)。结论全麻期间持续应用盐酸右美托咪定能有效维持血液动力学的稳定,降低围术期患者血糖、血浆皮质醇、肾上腺素、去甲肾上腺素水平,降低应激反应。

Objective To explore the effects of dexmedetomidine（Dex） on the stress reaction of patients in the perioperative period after intravenous-inhalation anesthesia. Methods Eighty patients of selective operation under intravenous-inhalation anesthesia,were randomized into 2 groups（n=40 in each group）.The patients in Dex group were infused with 1 μg/kg Dex for 15 min with the maintenance dose of 0.2 μg/（kg·h）,while in control group,the patients were infused with 20 ml 0.9% physiological saline for 15 min with the maintenance dose of 4 ml/h.Fentanyl-propofol-rocuronium was used for anesthesia induction,and sevenfluorine-propofol-cisatracurium was used for maintenance.The tube was extubated when breath resumed after operation.Arterial blood pressure,heart rate,blood sugar,plasma cortisol,epinephrine,noradrenalin were recorded at the time of entering OR（T0）,instant before the intubation（T1）,instant after the intubation（T2）,30 min after the intubation（T3）,instant after the extubation（T4）,30 min after the extubation（T5）. Results Compared with T0,SBP was decreased at T3 in Dex group（P0.05）.Compared with T0,SBP,DBP,HR was increased at T2,T3,T4 in control group（P0.05）.There was significant difference in arterial blood pressure and heart rate between two groups at T2,T3,T4（P0.05）.Compared with T0,plasma cortisol,epinephrine,noradrenalin were reduced at T3 in Dex group（P0.05）.Compared with T0,blood sugar,plasma cortisol,epinephrine,noradrenalin were increased at T2,T3,T4（P0.05）.There was significant difference in blood sugar,plasma cortisol,epinephrine,noradrenalin between two groups at T2,T3,T4（P0.05）. Conclusion Continuous use of Dex in intravenous-inhalation anesthesia will maintain the stable hemodynamics,decrease the levels of blood sugar,plasma cortisol,epinephrine,noradrenalin and reduce the stress reaction.