右美托咪定复合依托咪酯对高血压悬雍垂腭咽成形术患者血流动力学的影响

Effects of tracheal intubation with dexmedetomidine combined etomidate induced anesthesia on hemodynamic in hypertensive patients undergoing uvnlopalatopharyngoplasty

目的 探讨有美托咪定复合依托咪酯麻醉诱导对高血压悬雍垂腭咽成形术患者气管插管时的血流动力学影响.方法 选择高血压Ⅱ～Ⅲ级、睡眠呼吸暂停低通气指数25 ～ 45择期行悬雍垂腭咽成形术患者40例,完全随机分为右美托咪定复合依托咪酯麻醉诱导组（20例）、依托咪酯麻醉诱导组（20例）.右美托咪定复合依托咪酯麻醉诱导组麻醉诱导前给予负荷剂量右美托咪定0.6 μg/kg静脉注射,15 min内注射完毕,依托咪酯麻醉诱导组以0.9％氯化钠注射液注入.2组均以0.3 mg/kg依托咪酯快速麻醉诱导后经鼻腔气管插管.分别记录2组入室、气管插管即刻、插管后1、3、5 min的收缩压、舒张压、心率.结果 右美托咪定复合依托咪酯麻醉诱导组术前、插管即刻、插管后1、3、5 min收缩压分别为（169±13）、（126±10）、（120±10）、（117±13）、（112±16） mmHg（1 mmHg =0.133 kPa）;舒张压分别为（103±10）、（95±12）、（95±12）、（89±10）、（83±16） mmHg;心率分别为（89±12）、（89±10）、（84±15）、（85±12）、（83±12）次/min;依托咪酯麻醉诱导组术前、插管即刻、插管后1、3、5 min收缩压分别为（165±11）、（110±12）、（108±9）、（105±13）、（104±16） mmHg;舒张压分别为（106±11）、（79±13）、（75±6）、（79±12）、（76±10） mmHg;心率分别为（86±12）、（65±10）、（76±14）、（75±11）、（74±9）次/min.右美托咪定复合依托咪酯麻醉诱导组患者气管插管即刻、插管后1、3 min收缩压、舒张压、心率明显低于依托咪酯麻醉诱导组,差异有统计学意义（P＜0.05）.结论 右美托咪定复合依托咪酯麻醉诱导应用在高血压患者悬雍垂腭咽成形术中,可降低应激反应,维持气管插管期间循环的稳定.

Objective To study effects of tracheal intubation with dexmedetomidine combined etomidate induced anesthesia on hemodynamic in hypertensive patients undergoing uvnlopalatopharyngoplasty （UPPP）.Methods Forty hypertensive patients,grade Ⅱ to Ⅲ,apnea hypopnea index （AHI） from 25 to 45 undergoing UPPP were randomly divided into two groups：dexmedetomidine combined etomidate group（ED group,20 cases）,dexmedetomidine given a loading dose of 0.6 μg/kg intravenous injection,15 min after the injection before induction of anesthesia; etomidate group（EN group）with normal saline injection.The two groups were fast nasal tracheal intubation after induction of anesthesia with 0.3 mg/kg etomidate.It were recorded that systolic blood pressure,diastolic blood pressure,heart rate in intubation and 1,3,5 min after intubation.Results Dexmedetomidine combined etomidate induced of anesthesia before surgery,intubation,1min after intubation,3 min after intubation,5 minafterintubation systolic pressure were （169 ± 13）,（126 ± 10）,（120 ± 10）,（117 ± 13）,（112 ± 16） mmHg; diastolic blood pressure as （103 ± 10）,（95 ± 12）,（95 ± 12）,（89 ± 10）,（83 ± 16） mmHg; heart rate was （89 ± 12）,（89 ± 10）,（84 ± 15）,（85 ± 12）,（83 ± 12） times/min; etomidate induction of anesthesia before surgery,intubation,1 min after intubation,3 min after intubation,5 min after intubation systolic pressure were （165 ± 11）,（110 ± 12）,（108 ± 9）,（105 ± 13）,（104 ± 16） mmHg; diastolic blood pressure （respectively.106±11）,（79± 13）,（75 ±6）,（79±12）,（76± 10） mmHg; heart rate was （86± 12）,（65 ± 10）,（76 ± 14）,（75 ±11）,（74 ±9）times/min.Systolic blood pressure,diastolic blood pressure,heart rate in group ED was significantly lower than group EN,in endotracheal intubation,intubation after 1 min,3 min,there were statistically significant between two groups（P ＜0.05）.Conclusion Dexmedetomidine combined etomidate induced anesthesia in patients with hypertension uvnlopalatopharyngoplasty can reduce stress and maintain the stability of circulation during tracheal intubation.