右美托咪定辅助开胸手术全身麻醉的应用

Application of dexmedetomidine as an systemic anesthetic adjunct in thoracic surgery

目的观察开胸手术中应用右美托咪定(DEX)辅助全身麻醉的有效性及安全性。方法择期行开胸手术患者40例,随机双盲分为2组:对照组(C组)和DEX组(D组),每组20例。D组于麻醉诱导前泵入DEX负荷剂量1μg/kg,15 min泵注完,继以0.2μg/(kg.h)持续泵注至术毕;C组以同样方式输注生理盐水。分别记录两组患者在麻醉诱导前(T0)、气管插管前(T1)、气管插管后(T2)、开胸时(T3)以及手术结束时(T4)的心率(HR)、血压(SBP、DBP)及T0、T2～T4时点患者血浆中去甲肾上腺素和肾上腺素的浓度,统计全麻时丙泊酚和七氟烷的用量,同时观察苏醒期躁动、恶心呕吐、寒战及清醒后伤口疼痛发生情况。结果 C组在T2～T4时点的SBP、DBP、HR上升幅度较D组更显著(P<0.05)。在T3和T4时,D组患者血浆中去甲肾上腺素的浓度增加的程度相对C组较低(P<0.05)。术后D组患者寒战、躁动及切口痛发生率低于C组,且D组丙泊酚和七氟烷的用量明显少于C组(P<0.05)。结论应用右美托咪定辅助开胸手术麻醉能降低患者血浆中去甲肾上腺素的水平,减弱气管插管和手术刺激引起的应激反应,使血压平稳,降低了术后并发症的发生率。

Objective To investigate the efficacy and safety of dexmedetomidine（DEX）as an systemic anesthetic adjunct in thoracic surgery.Methods 40 selective thoracic surgery patients were randomly divided into control group（group C）and DEX group（group D）,20 patients in each group.Patients in group D received intravenous injection of DEX（1 μg/kg）15 min before intubation,and then received continuous injection of DEX at a rate of 0.2 μg/（kg · h）during the operation;while in group C,physiological saline was used instead of DEX.HR and BP were determined before anesthesia（T0）,before intubation（T1）,after intubation（T2）,at the time of open thoraces（T3）and at the end of surgery（T4）.Meanwhile,the levels of epinephrine and norepinephrine were determined at T0,T2~T4 in both groups.The number of cases of postoperative shivering,restlessness nad incisional pain was recorded respectively.Results DEX could effectively reduce the plasma levels of norepinephrine（P0.05）,simultaneously,SBP,DAP of group C were increased significantly than those of group D at T2~T4（P0.05）.The levels of norepinephrine at T2~T4 were increased significantly（P0.05）,and the increase of group C was significantly higher than that in group D at the same time points（P0.05）.The incidence of postoperative shivering,restlessness and incisional pain was less in group D than that in group C.Conclusion DEX as an systemic anesthetic adjunct in thoracic surgery can reduce plasma levels of norepinephrine,weaken the tracheal intubation and surgical stimulation of the stress response,and reduce the incidence of interoperatie blood pressure fluctuations and postoperative complications.