右美托咪定与硫酸镁应用于腹腔镜手术对患者应激反应的影响比较

Comparison of Effects of Dexmedetomidine and Magnesium Sulfate on Stress Response during Laparoscopic Surgery

目的比较右美托咪定和硫酸镁对行腹腔镜胆囊切除患者应激反应的影响。方法 60例择期行腹腔镜胆囊切除术患者,将其按随机数字表法分为生理盐水组(C组)、右美托咪定组(D组)和硫酸镁组(M组),每组20例。C组予以生理盐水50mL、D组予右美托咪定1μg·kg-1稀释至50mL,M组予以硫酸镁50mg·kg-1稀释至50mL,均于诱导插管完成后至气腹前静脉泵注,泵注时间为1 5min。记录3组诱导前(T0),泵注毕(T1),气腹后5min(T2)、10min(T3)、20min(T4)、30min(T5),气腹关闭即刻(T6)的心率与血压。分别于T0、T2、T4、T6时取静脉血3mL,测定血肾上腺素(E)、去甲肾上腺素(NE)及血糖(BG)水平。记录患者气腹时间、苏醒时间、拔管时间以及不良反应发生情况。结果 T1—T6时点,C组SBP、DBP和HR显著高于其他2组(P<0.05),M组与D组相比差异无统计学意义(P>0.05)。T2、T4、T6时点,C组E和NE水平较D组及M组显著升高(P<0.05),但M组与D组差异无统计学意义(P>0.05)。与T0比较,C组T1—T6时点,SBP、DBP和HR显著升高(P<0.05),E和NE浓度在T2、T4、T6时点显著升高(P<0.05);3组BG在T4、T6时点升高(P<0.05),但C组升高幅度高于D、M组(P<0.05)。M组苏醒时间、拔管时间较D、C组延迟(P<0.05),D组与C组差异无统计学意义(P>0.05)。结论气腹前辅以硫酸镁与右美托咪定均能有效减轻CO2气腹的心血管应激反应,抑制血压心率、E、NE和BG的升高,但相比于右美托咪定,硫酸镁可导致患者苏醒延迟。

Objective To compare the effects of dexmedetomidine and magnesium sulfate on stress response in patients undergoing laparoscopic surgery.Methods Sixty patients undergoing elective laparoscopic cholecystectomy were randomly infused with 50mL normal saline（group C,n=20）,1μg·kg-1 dexmedetomidine dissolved in 50mL normal saline（group D,n=20）or 50mg·kg-1magnesium sulfate dissolved in 50mL normal saline（group D,n=20）for 15minutes after intubation and before pneumoperitoneum.Blood pressure and heart rate（HR）were recorded before anesthesia induction（T0）,at the end of infusion（T1）,5minutes after pneumoperitoneum（T2）,10minutes after pneumoperitoneum（T3）,20minutes after pneumoperitoneum（T4）,30minutes after pneumoperitoneum（T5）and at the end of pneumoperitoneum（T6）.Blood samples（3mL）were taken at T0,T2,T4and T6to determine the levels of epinephrine（E）,norepinephrine（NE）and blood glucose（BG）.In addition,pneumoperitoneum time,awakening time,extubation time and adverse reactions were recorded.Results Compared with group C,systolic blood pressure（SBP）,diastolic blood pressure（DBP）and HR at T1-T6and concentrations of E and NE at T2,T4and T6significantly decreased in group D and group M（P〈0.05）.But there were no significant differences in theses parameters between group D and group M（P〈0.05）.Compared with T0,the SBP,DBP and HR increased at T1-T6and concentrations of E and NE increased at T2,T4and T6in group C（P〈0.05）.In all three groups,BG levels increased at T4and T6（P〈0.05）.However,the increase in BG levels in group C was more obvious than that in group D and group M（P〉0.05）.Compared with group M,both dexmedetomidine and magnesium sulfate caused significantly prolonged awakening and extubation time.But there were no significant differences in awakening and extubation time between group D and group C（P〉0.05）.Conclusion Theadministration of dexmedetomidine or magnesium sulfate before pneumoperitoneum can reduce cardiovascular stress response and inhibit the increase in blood pressure,HR and levels of E,NE and BG.But compared with dexmedetomidine,magnesium sulfate leads to a prolonged awakening time.