右旋美托咪啶在高血压患者腹腔镜胆囊切除术中的应用

Application of dexmedetomidine to laparoscopic cholecystectomy in patients with hypertension

目的观察右旋美托咪啶对高血压患者腹腔镜胆囊切除术围麻醉期血流动力学的影响。方法 78例高血压单纯性胆囊结石患者,术前血压均控制在正常范围内,随机均分为两组:A组(右旋美托咪啶组):开放上肢外周静脉后,静注右旋美托咪啶1.0μg/kg,10 min泵完,芬太尼4μg/kg,丙泊酚2 mg/kg,阿曲库铵0.5 mg/kg,诱导插管后,持续由麻醉机吸入七氟醚1~1.5 MAC,右旋美托咪啶0.5μg/(kg·h)静脉泵注至缝皮,待患者自主呼吸恢复、神志清醒后拔管。B组(咪达唑仑组):静注咪达唑仑40μg/kg,芬太尼4μg/kg,丙泊酚2 mg/kg,阿曲库铵0.5 mg/kg诱导插管后,继以七氟醚1~1.5 MAC吸入,咪达唑仑50μg/(kg·h)泵至缝皮,待自主呼吸恢复后清醒拔管。检测并记录患者入室后(T1)、插管后即刻(T2)、清醒后准备拔管前(T3)、拔管后即刻(T4)的血压(BP)、心率(HR)、去甲肾上腺素(NE)、肾上腺素(E)。结果 A组T2、T3、T4时BP、HR和血浆NE、E值均明显低于同时间点B组(P<0.01);A组T2、T3、T4时BP、HR和血浆NE、E值与T1时相比无明显差异(P>0.05);而B组T2、T3、T4时BP、HR和血浆NE、E值均明显高于T1(P<0.01)。结论右旋美托咪啶辅助全麻用药,能维持高血压患者全麻诱导、插管和拔管期间循环功能稳定,抑制围麻醉期的应激反应。

Objective To observe the effcts of dexmedetomidine on the hemodynamics of pgtients with hypertension who undertake laparoscopic cholecystectomy during the anesthetic period. Methods Seventy eight patients with hypertension and simple cholecystolithiasis were randomly divided into two groups. Their blood pressure was control within the normal limits b^fore the operation. After the opening of the peripheral veins in the upper limbs, group A completed the intravenous injection with 1： 0 μg/kg dexmedetomidine within 10 min and received 4 μg/kg fentanyl,2 mg/kg propofol, and 0.5 mg/kg atracurium. After the induced intubation,this group continuously inhaled sevoflurane 1-1.5 MAC by the help of anesthetic machine, and received the pump injection with 0.5 μg/（ kg · h）dexmedetomidine until the skin closure. After the patients regained spontaneously breathing and mind, the extubation was carried out. Group B received the intravenous injection with 40 μg/kg midazolam, 4 μg/kg fentanyl, and 2 mg/kg propofol. After the intubation induced with 0.5 mg/kg atracurium,the patients continuously inhaled sevoilurane 1-1.5 MAC by the hdp of anesthetic machine and received the pump injection with 50 μg/（ kg · h） midazolam until the skin closure. After the patients regained spontaneously breathing and mind, the extubation was carried out. The patients blood pressure （ BP）, heart rate （ HR）, norepinephrine （NE） ,and erenaline（E） were measured and recoreded at the time of entering into the room（ T11 ） ,intubation（ T2 ） ,pre-extubation after the recovery of consciousness（T3 ） ,and extubation（T4 ）. ResultsThe BP,HR,and the average level of NE and E at T2 ,T3 ,and T4 in group A were significantly lower than those at the same time points in group B （ P 〈 0.01 ）. In group A, there was no significant difference in the BP, HR, and the average level of NE and E between at T2, T3, and T4 and those at T1 （ P 〉 0.05 ）. Those indexes in group B at T2, T3 , and T4 were higher than those at T1 （ P 〈 0.01 ）. Conclusion Adjuvant use of dexmedetomidine can maintain the stability of the circulation and inhibit stress response in patients with hypertension during the general anesthesia induction, intubation, and extubation.