右美托咪啶预防全麻气管插管和拔管心血管反应的临床观察

Clinical observation of dexmedetomidine in prevention from cardiovascular response to tracheal intubation and extubation during general anesthesia

目的观察右美托咪啶预防全身麻醉气管插管和拔管过程中心血管反应的临床效果。方法选择30例拟在全身麻醉下行择期腹部手术的患者(ASAⅠ～Ⅱ级),随机分为2组:对照组(C组)和右美托咪啶组(D组),每组15例。D组全麻诱导前静脉泵注右美托咪啶1 ug/kg,15 min泵注完;C组则静脉泵注等量的生理盐水。两组诱导用药均为丙泊酚1.5 mg/kg,芬太尼3μg/kg及顺式阿曲库铵0.2 mg/kg。记录并比较下列各时间点两组患者的平均动脉压(MAP)、心率(HR)、心率收缩压乘积(RPP)的变化:①注药前(基础值),DEX或生理盐水输注后5、10、15min;②插管前1 min,插管即刻,插管后1、3、5 min;③拔管前5 min,拔管即刻,拔管后3、5、10min。记录两组插管和拔管期间RPP>12000的发生情况。结果D组注药后10、15、插管前1 min的HR较基础值下降(P<0.05)。D组插管即刻、插管后1 min、拔管时的MAP和HR均明显低于C组(P<0.05)。注药后15 min至拔管后各时间点D组患者的RPP均低于C组(P<0.05)。D组在插管和拔管期间RPP>12000的发生率明显小于C组(P<0.05)。两组患者的苏醒时间、拔管时间和Ramsay评分比较差异无统计学意义。结论右美托咪啶能显著减轻气管插管和拔管时的心血管反应,维持血流动力学的稳定,同时对麻醉恢复期没有影响。

Objective To evaluate the effect of dexmedetomidine in preventing cardiovascular response induced by tracheal intubation and extubation during general anesthesia. Methods A total of 30 patients （ASA Ⅰ - Ⅱ ）underwent selective abdominal operation under general anesthesia were randomly divided into two groups： control group （group C, n=15 ） and dexmedetomidine group （group D,n=15）. The patients in group D received dexmedetomidine 1 ug/kg intravenous injection over 15 min while those in group C received equal volume of normal saline before anesthesia induction. Anesthesia was induced with propofol 1.5 mg/kg, fentanyl 3 μ,g/kg and cisatracurium 0.2 mg/kg in both groups. Mean arterial blood pressure （MAP）, heart rate （HR） and the rate-pressure product （RPP） were recorded at these moment： ① before infusion （baseline value）, 5 min, 10 rain and 15 min after infusion; ② lmin before intubation, the moment of intubation, 1 rain,3 min and 5 rain after intubation; ③ 5rain before extubation, the moment of extubation, and 3 rain,5 rain and 10 rain after extubation.The incidences of RPP more than 12000 were caculated during intubation and extubation. Results At 10, 15 rain after infusion and 1 rain before intubation,HR significantly decreased in group D,compared with the baseline value （P〈0.05）. At the moment of intubation,1 rain after intubation, and the moment of extubation, MAP and HR significantly decreased in group D, compared with group C （P〈0.05）. At each time point from 15 min after infusion to after extubation, RPP significantly decreased in group D, compared with group C （P〈0.05）. The incidences of RPP morethan 12000 in group D were significantly less than that in group C during intubation and extubation （P〈0.05）.There were no significant differences in the recovery time, extubation time and Ramsay conscious-sedation score between the two groups （P〉0.05）. Conclusion Dexmedetomidine can effectively reduce cardiovascular responses to tracheal intubation and extubation during general anesthesia,and have hemodynamic-stabilizing effects while not prolonging the recovery time from anesthesia.