右美托咪定对胸腔镜手术患者围拔管期应激反应的影响

The clinical effect of dexmedtomidine at ease the patients' stress respond around the time of tube drawing in thoracoscope surgery with general anesthesia

摘要：目的探讨右关托咪定在减轻胸腔镜手术患者全麻围拔管期应激反应中的作用。方法选择择期于双腔管气管插管全身麻醉下行胸腔镜手术的患者60例（ASAI-Ⅱ），随机分为两组：右关托咪定组（Dex 0．5μg·kg,n=30）和对照组（生理盐水10mL，n=30），记录相应时点患者的心率（HR）、呼吸频率（RR）、收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）及脑电双频谱指数（BIS）值；记录麻醉前、吸痰时、拔管即刻、拔管后2、6min血中去甲肾上腺素（NE）、肾上腺素（E）浓度。结果与对照组比较，右关托咪定组于拔管前血压、心率平稳，于导管内吸痰、拔管时及拔管后2、6min SBP、DBP、MAP、HR及血中去甲肾上腺素、肾上腺素浓度上升幅度较小，组间比较其差异有统计学意义（P〈0．05）。结论右美托咪定可有效减轻全麻胸腔镜手术患者围拔管期应激反应。

Objective Discusses the clinical effect of dexmedtomidine at ease the patients＇ stress respond around the time of tube drawing in thoracoscope surgery with general anesthesia. Methods Choosing 60 cases of surgical patients ac- cepting the double cavity tracheal intubation surgical operation under the condition of general anesthesia （ ASAⅠ - Ⅱ lev- el） , the 60 cases are divided into two groups ： Dex group is the patients who took DEX （ Dex 0.5 μg . kg , n = 30 ） and Comparison group is the comparison group （physiological saline 10 mL,n = 30）. Recording the patients＇ heart rate（HR） , respiring rate（ RR）, systolic pressure（ SBP）, diastolic pressure（ DBP）, average arterial pressure（MAP）, the index of brain electricity double frequency spectrum before the anesthesia, before using medication, during the corresponding time points. Recording Norepinephrine （ NE ） in blood, adrenaline （ E ） density before anesthesia, aspiration of sputum, at the time of de- cannulation ,2,6 minutes after the decannulation as well as the grade of vigilance and calmness 2,4,6,10,15 minutes after extubation. Results Compared with comparison group,blood pressure and heart rate of Dex group is steady before deeannu- lation, the rising degree of norepinephrine and adrenaline density was less obvious during the period of inner catheter aspira- tion sputum. The same result occurs to SBP, DBP, MAP, HR 2,4 minutes after the decannulation. The level will come back to the normal degree before the decannulation 10 minutes after the operation, there being a statistic significance comparing the research results between these 2 groups （ P 〈 O. 05 ）. Conclusion Dexmedtomidine can ease the patients＇ stress respond obviously around the time of tube drawing in thoracoseope surgery with general anesthesia.