右美托咪定用于预防全身麻醉下双腔气管导管插管心血管反应的临床观察

Clinical observation of dexmedetomidine to prevent the cardiovascular responses to double-lumen endotracheal intubation during general anesthesia

目的观察右美托咪定（DXM）用于预防双腔气管导管插管心血管反应的效果。方法将ASAI-Ⅱ级拟在全身麻醉下行双腔气管导管插管的80例患者随机分成右美托咪定组和对照组，每组40例。右关托咪定组诱导前静脉泵注右关托咪定0．5μg／b，5min泵注完；对照组同样方法泵注等量生理盐水。两组诱导用药均用舒芬太尼0．3μg/kg，罗库溴铵1mg／kg，丙泊酚2mg／kg。对两组给药前，给药后，插管前，插管时，插管后1、3、5min的收缩压（SBP）、舒张压（DBP）、心率（HR）进行比较。结果两组患者插管时及插管后1minBP、HR均有不同程度升高，右美托咪定组升高程度明显小于对照组（P〈0．01），在未加深麻醉的前提下，右美托咪定组的BP、HR在插管后3、5min较插管后1min明显下降，与插管前相似。而对照组与插管后1min对比无明显变化（P〉0．05），明显高于右美托咪定组（P〈0．01）。右美托咪定组有2例患者出现明显心动过缓，给予阿托品0．5mg后纠正。结论右美托咪定可以显著减轻双腔气管导管的心血管反应，有助于维持血流动力学的稳定。

Objective To observe the effect of dexmedetomidine on preventing the cardiovascular response to double lumen endotracheal tube intubation. Methods Eighty ASA I -Ⅱ patients scheduled to have double-lumen endotracheal intubation under general anesthesia were randomly divided into two groups, dexmedetomidine group and control group, 40 patients in each group. Dexmedetomidine was intravenous infused dating 0. 5 μg/kg, 5 min infusion finished before induction in de^medetomidine group. The control group was in the same way pumpl infused with normal saline. Induced drug in both groups were sufentanil 0. 3 μg/kg, rocuronium 1 mg/kg, propofol 2 mg/kg. Systolic blood pressure （SBP）, diastolic blood pressure （DBP）, heart rate （HR） at the time before and after administred drugs, before and during intubation, and 1 min, 3 min, 5 min after intubation were compared between the two groups. Results The values of BP and HR in dexmedetomidine group after intubation for 1 min were increased to varying degrees, the dexmedetomidine group increased significantly less than the control group （P 〈0. 01 ）. Under no deepen anesthesia, the values of BP and HR in dexmedetomidine group after intubation for 3 min and 5 min decreased compared with after intubation 1 min, and similar to values before intubation. There was no significant changes in the control group after intubation for 1 minute （P 〉 0. 05）, but significantly higher than that of dexmedetomidine group （P 〈 0.01 ）. There were 2 patients in dexmedetomidine group occurred significant bradycardia and were corrected by atropine 0.5 mg. Conclusions Dexmedetomidine can significantly reduce the cardiovascular responses to doub- le-lumen endotracheal tube, and help to maintain hemodynamic stability.