右美托咪啶对全身麻醉拔管期应激反应的影响

目的评估术中持续静脉输注右美托咪啶对全身麻醉拔管期应激反应的影响。方法60例全麻下择期行腹部手术患者随机分为右美托咪啶组（D组）和对照组（C组），各30例。全麻诱导开始，D组患者接受持续静脉输注浓度4μg／ml右美托咪啶0．3～0．7μg／（kg·h），C组患者接受持续静脉输注等量生理盐水，持续输注至手术结束前30min。观察拔管前（TO）、拔管即刻（T1）、拔管后3min（T2）、10min（T3）平均动脉压（MAP）、心率（HR）、动脉血氧饱和度（SpO2）。用放射免疫法检测各时点血浆中。肾上腺素（E）、去甲肾上腺素（NE）和促肾上腺皮质激素（ACTH）含量。结果右美托咪啶组在拔管期间血液动力学平稳，与对照组相比，MAP和HR在拔管即刻以及拔管后3、10min无明显升高；与基础值相比，对照组吸痰拔管时及拔管后3、10min时MAP、HR均明显升高，尤以拔管时明显；D组T1、T2、T3三个时点血浆E、NE和ACTH含量明显低于C组（P均〈0．05）。结论术中持续静脉输注右美托咪啶可减少麻醉拔管应激引起的神经内分泌反应，稳定血流动力学，减轻全麻患者气管拔管引起的心血管反应，可以安全地应用于全麻患者气管拔管。

Objective To evaluate the effects of dexmedetomidine hydrochloride on stress reaction by continuous infusion during the period of extubation of general anesthesia. Methods Sixty patients undergoing abdominal surgery in general anesthesia were randomly divided into the control group （ C ） . and dexmedetomidine group （ D ） .The patients were intravenously administered with normal saline （ Group C ） or dexmedetomidine 0.3-0.7ug/kg/hr （ Group D ） until 30 minutes before the end of operation. In two groups, MAP, HR and SP02 were monitored and venous blood samples were taken for determination of epinephrine （ E ） , norepinephrine （ NE ） and adrenocorticotrophichormone （ ACTH ） concentrations at time points before extubation （ TO ） , extubation （ T1 ） 3 min after extubation （ T2 ） and 10 min after extubation （ T3 ） . Results The MAP and HR were relatively stable in the period of extubation in dexmedetomidine group. At T1, T2 and T3, MAP and HR in control group were clearly higher than those in dexmedetomidine group （ P〈0.05orP〈0.01 ） .Also the concentrations of epinephrine, norepinephrine and adrenocorticotrophichormone in group C were higher than those in Group D （ P〈0.05orP〈0.01 ） Conclusions Continuous infusion of dexmedetomidine hydrochloride with 0.3-0.Tug/kg/hr can prevent the stress reaction during extubation with more stable hemodynamics. Dexmedetomidine is effective and safe during the period of extubation of general anesthesia.