右美托咪定不同给药方式对全麻气管插管应激反应的影响

Effects of dexmedetomidine administrated in different modes on the stress reaction of endotracheal intubation

目的：观察右美托咪定（dexmedetomidine， DEX）不同给药方式对全麻气管插管应激反应的影响。方法择期全麻手术患者90例，ASA分级Ⅰ级或Ⅱ级。随机分为三组（ n＝30）：DEX滴鼻组（N组）、DEX静脉组（V组）和对照组（C组）。 N组鼻腔内滴注DEX 1μg/kg（1 mL），滴鼻同时静脉输注生理盐水20 mL，输注时间10 min；V组鼻腔内滴注生理盐水1 mL，同时静脉输注DEX 1μg/kg；C组分别鼻腔滴注、静脉输注生理盐水。各组静脉输注结束后行麻醉诱导及气管插管。于入室后（ T0），滴鼻后5 min（ T1）、10 min（ T2），气管插管后1 min（ T3）、3 min（ T4）、5 min （ T5）记录患者MAP、HR和BIS值并于T0、T3、T4、T5时间点抽取右肘静脉血样，检测血浆皮质醇浓度（ Cor）和血糖（ Glu）。记录各组发生低氧血症（ SpO2＜90％）、高血压或低血压的情况。结果 C组MAP、HR、血Cor和Glu在气管插管后明显升高（P＜0．05）；N组和V组在T2时间点HR明显降低（P＜0．05），气管插管后MAP、HR、血Cor和Glu波动较轻，且较C组明显降低（P＜0.05）；各组患者在滴鼻及静脉输注过程中均无不适主诉和低氧血症，且血流动力学稳定。结论 DEX两种给药方式均可有效地抑制气管插管时的应激反应，且经鼻滴入方法简单安全，耐受性好。

Objective To observe the effects of dexmedetomidine （ DEX ） administrated in different modes on the stress reaction in patients undergoing endotracheal intubation .Methods In this prospective , randomized , double-blind study , 90 ASAⅠand Ⅱ patients undergoing selective general anesthesia were included .The patients were randomly allocated to three groups （ n =30 ）： DEX intranasal group （ group N ） , DEX intravenous group （ group V ） and control group （ group C ） .DEX were given 1 μg/kg in 1 ml intranasally and at the same time 20 ml of normal saline （ NS） was infused intravenously within 10 min just before induction of anesthesia in group N; in group V, 1 ml NS was given intranasally and dexmedetomidine 1 μg/kg in 20 ml was infused intravenously in the same way;and NS were given intranasally and intravenously respectively in the same way in group C .General anesthesia induction and endotracheal intubation were taken when the infusion were finished .MAP, HR and BIS were recorded at OR（T0）, 5 min and 10 min after intranasal administration （T1,T2）, 1 min （T3）, 3 min （T4） and 5 min （T5） after endotracheal intubation （P〈0.05）;blood samples were taken at T0 , T3 , T4 , T5 to detect plasma cortisol concentration and blood glucose;the occurrence of hypoxemia （SpO2 〈90%）, hypertension or hypotension were also recorded .Results MAP, HR, plasma cortisol concentration and blood glucose in group C were significantly higher after endotracheal intubation in group C （ P〈0.05）;HR was significantly lower at T 2 and MAP, HR, plasma cortisol concentration and blood glucose fluctuated slightly and were significantly lower after endotracheal intubation in both group N＆amp;nbsp;and group V （P 〈0.05）.There was no discomfort and hypoxemia during intranasal and intravenous administration, and the hemodynamics were stable in all groups . Conclusion Both modes of dexmedetomidine administration can inhibit the stress reaction effectively in patients undergoing endotracheal intubation .Furthermore, the administration of intranasal is simple , safe and well tolerant .