右旋美托咪啶的镇静效应及对气管插管血流动力学的影响

The sedative effect of dexmedetomidine and the hemodynamic influence of dexmedetomidine on tracheal intubation

目的研究右旋美托咪啶（dexmedetomidine，Dex）对听觉诱发电位指数（auditoryevokedpotentialindex，AAI）的影响和对气管插管血流动力学的影响。方法择期手术患者60例（ASAⅠ～Ⅱ级），采用随机数字表法随机分成Dex组（D组）和对照组（C组）：D组静脉泵注Dex负荷剂量1μg／kg（20rain泵完）；C组以同样方式泵注生理盐水。泵注完成2min后诱导插管，记录泵药前（T0）、诱导前（T1）、插管前（T2）、插管后即刻（rr3）、插管后3（T4）、5（1r5）、10min（T6）的收缩压（SBP）、平均动脉压（MAP）、舒张压（DBP）、心率（HR）、脉搏氧饱和度（SpO2）和AAI。结果两组患者术前一般情况基本相同，D组的AAI值在Tn和T1时点分别为（62±5）和（35±6）（P〈0．01），下降约53％，而C组的AAI值在泵药前后无明显变化。在插管后即刻D组的SBP、MAP、DBP和HR分别为[（112±18）、（90±19）、（80±19）mmHg（1mmHg=O．133kPa）、（81±14）次／min]，与C组[（140±21）、（109±16）、（97±17）mmHg、（95±10）次／min]比较差异有统计学意义（P〈0．05）。结论Dex可以产生良好的镇静作用．并且能够抑制患者的气管插管血流动力学反应。

Objective To study the influence of dexmedetomidine （Dex） on auditory evoked potential index （AAI） and its hemodynamic influence as tracheal intubation. Methods 60 patients were randomized divided into dexmedetomidine group（D group） or control group（C group）. Patients were intravenously pumped into Dex 1 μg/kg with in 20 rain in D group＇, the same volume placebo was administered in C group. Tracheal intubation was done 2 rain after medication. Systolic blood pressure （SBP）, mean arterial pressure（MAP）, diastolic blood pressure（DBP）, heart rates（HR）, pulse oxygen saturation（SpO/） and AAI were recorded at the following time points （before medication, before induction, before intubation, the time after intubation, 3 rain after intubation, 5 min after intubation and 10 rain after intubation）. Results Before medication, the general conditions have no difference in two groups. The values of AAI before medication and before induction were （62±5） and （35±6）（P〈0.05） respectively, decreased by 53%, and there were no difference in C group. The SBP, MAP, DBP and HR at the time after intubation in D group were （112±18）, （90±19）, （80±19） mm Hg（1 mmHg=0.133 kPa） and （81±14） beat/min respectively, while in C group were （140.±21）, （109±16）, （97±17） mm Hg, （95±10） beat/min respectively, there were significant difference between the two groups（P〈0.05）. Conclusions Dex has good sedative effects before surgery, and it can also depress the stress responses of tracheal intubation effectively.