右美托咪定抑制全麻下止血带相关反应的临床研究

Clinical research of dexmedetomidine hydrochloride for tourniquet related problems under general anesthesia

目的探讨右美托咪定(DEX)是否可以有效抑制止血带相关高血流动力学反应,降低RPP。方法全身麻醉下行单侧膝关节置换术患者80例,ASAⅠ～Ⅲ级,随机分为右美托咪定组(D组,n=41)和对照组(C组,n=39)。常规麻醉诱导后七氟醚吸入维持麻醉,调节其浓度,维持BIS值40～60。D组给予1μg/kg负荷剂量(20min)后以0.4μg·kg-1·h-1维持,C组予以等量生理盐水。比较麻醉诱导前(T0)、止血带充气即刻(T1)、充气后20min(T2)、充气后30min(T3)、充气后40min(T4)、充气后50 min(T5)、充气后60 min(T6)HR、SBP、RPP、BIS、CETSev和MAC。结果与C组比较,D组T2～T6时HR明显减慢,SBP、RPP明显降低(P<0.05);与T0时比较,D组T2～T6时HR明显减慢,SBP、RPP明显降低,C组T4～T6时RPP、T6时SBP明显降低(P<0.05)。与C组比较,D组CETSev在T4～T6时,MAC在T3～T6时均明显降低(P<0.05)。结论右美托咪定可显著抑制止血带相关高血流动力学反应,减慢HR、降低SBP,减少RPP并降低MAC和CETSev,减少七氟醚吸入剂量。

Objective To evaluate whether dexmedetomidine （DEX） could inhibit tourniquet induced high hemodynamic response or reduce RPP. And whether DEX has impact on the minimum alveolar（MAC） and end-tidal concentration of sevoflurane （Crr Sev）. Methods Eighty patients undergoing total knee arthroplasty operation, ASA I-HI were randomized into two groups., group D （DEX, n =41） and group C （saline, n = 39）. After induction of general anesthesia, sevoflurane was inhaled to maintain the BIS value of 40-60. In group D, a continuous infusion of DEX （1 μg/kg for 20 minutes for loading dose and followed by 0.4 11g·kg^-1 ·h^-1 ） was used till the end of surgery, whereas group C received an equivalent volume of saline. HR, SBP, RPP, BIS, CETSev and MAC values of sevoflurane were recorded before induction （T0）, right after inflation （T1）, 20 min （T2）, 30 min （Ta）, 40 rain （TO）, 50 rain （Ts）, 60 min （T0）.Results Compared with group C, HR,SBP,RPPof group D were significantly lower at T2-T6 （P〈0. 05） ; Compared with To, HR, SBP, RPP at T2-T0 in group D and RPP at T4-T6, SBP at To in group C were decreased （P〈0. 05）. The CrrSev and MAC values of sevoflurane in group D were significantly lower than those of the group C at T4-T6 （P 〈 0. 05 ）. Condusion Dexmedetomidine could significantly decrease the incidence of tourniquet induced high hemodynamic response, HR, SBP, and reduce RPP, MAC and CErSev.