右美托咪定预先给药对高血压冠心病病人诱导插管时血流动力学的影响

Effects of dexmedetomidine premedication on the hemodynamics in patient with hypertension and coronary heart disease during anesthetic induction and tracheal intubation

目的:探讨右美托咪定预先给药对高血压冠心病病人诱导插管时血流动力学的影响。方法:择期行上腹部手术合并高血压冠心病患者60例,男女各30例。随机均分为两组(n=30):对照组(C组)和DEX组(D组)。分别在麻醉诱导前15min泵注右美托咪定(D组)15ml(右美托咪定用量1.0μg/kg)和等量生理盐水(C组),输注时间15min。麻醉诱导后且肌松完全时经口气管插管行机械通气,记录输注右美托咪定前(T0)、气管插管前(T1)、气管插管即刻(T2)、气管插管后1、3、5、10min(T3～6)时BP、HR和心率收缩压乘积(RPP);抽静脉血测定血浆去甲肾上腺素(NE)和肾上腺素(E)浓度。结果:与T0时比较,C组BP、HR从T1到T5各时点是先明显下降后明显升高(Ρ?0.05),RPP在T3～5时点明显升高(Ρ?0.01),D组变化不明显,组间比较差异有统计学意义(Ρ?0.05)。与T0时比较,C组E和NE浓度水平在T3～5时点明显升高(Ρ?0.05),而D组变化不明显;组间比较差异有统计学意义(Ρ?0.05)。结论:右美托咪定预先给药可安全、有效的缓解高血压冠心病病人诱导插管时的心血管反应。

Objective：To investigate the effects of dexmedetomidine premedication on the hemodynamics in patients with hypertension and coronary heart disease during anesthetic induction and tracheal intubation.Methods：Sixty patients（30 males and 30 females） with hypertension and coronary heart disease scheduled for upper abdominal surgery were enrolled in this study.Patients were randomized into two groups（n=30 each）：group C=control;group D= dexmedetomidine.15ml of titrated dexmedetomidine（1.0μg/kg） were administered to patients in group D by a infusion pump 15 min prior to anesthetic induction.While patients in group C received the same volume normal saline.The infusion lasted 15min.After anesthetic induction,tracheal intubation was achieved and then ventilated.BP（Blood pressure）,HR（heart rate）,RPP（rate pressure product） were respectively recorded at the following time points：before infusion of dexmedetomidine（T0）,immediately before tracheal intubation（T1）,the moment of tracheal intubation（T2）,1,3,5 and 10 min after tracheal intubation（T3～6）.Venous blood samples were obtained for analysis of norepinephrine（NE） and epinephrine（E） levels at T0,T3～6.Results：Compared with T0,BP and HR were significantly decreased then increased from T1 to T5（P﹤0.05） and RPP were significantly higher at T3～5than those in group C（P0.01）.These above-mentioned variables had no significant change in group D.Statistically significant differences were found between the two groups（P0.05）.The levels of NE and E were significantly higher at T3～5 than those at T0 in group C（P0.05） but had no significant differences at these time points in group D.Statistically significant differences were found between the two groups（P0.05）.Conclusion： Dexmedetomidine premedication can safely and effectively alleviate the cardiovascular response in patients with hypertension and coronary heart disease during anesthetic induction and tracheal intubation.