辅用右美托咪定全麻诱导对麻黄碱升压效应的影响

Effect of general anesthesia induction assisted dexmedetomidine on pressor responses to ephedrine

目的：观察辅用右美托咪定全麻诱导对麻黄碱升压效应的影响。方法择期行腹腔镜胆囊切除术患者44例，年龄18～65岁，随机分为生理盐水组（N 组）和右美托咪定组（D 组）。D 组麻醉诱导前泵注右美托咪定0.8μg／kg，15 min 后改为0.4μg·kg^－1·h^－1维持，同时开始麻醉诱导和气管插管，插管后5 min 给予麻黄碱0.1 mg／kg。N 组诱导前以同样方式泵注生理盐水，余同 D组。记录泵注右美托咪定或生理盐水前（T0）、麻醉诱导前（T1）、插管即刻（T2）、插管后2 min（T3）、给麻黄碱即刻（T4）及之后2 min（T5）、5 min（T6）、10 min（T7）、15 min（T8）的 SBP、DBP 和 HR。结果与T0时比较，T2时 N 组 SBP、DBP 明显升高，HR 明显增快（P＜0.05或 P＜0.01），其余时点SBP、DBP 均明显降低（P＜0.05或 P＜0.01），T4、T7和 T8时 HR 明显减慢（P＜0.05或 P＜0.01）；D 组在 T1～T8时的 SBP、T1～T4和 T8时的 DBP 明显降低，T1和 T3～T4时的 HR 均明显减慢（P＜0.05或 P＜0.01）。与 T2时比较，T3、T4时 N 组 SBP、DBP 明显降低，HR 明显减慢（P＜0.01）；D组仅 T4时 SBP 明显降低（P＜0.01）。与 T4时比较，T5、T6时 N 组 SBP 明显升高（P＜0.05或 P＜0.01）；T5～T7时 D 组 SBP、DBP 明显升高，HR 明显增快（P＜0.01）。与 N 组比较，T1～T3时 D 组HR 明显减慢（P＜0.05或 P＜0.01），T2时 D 组 SBP、DBP 明显降低（P＜0.01），T5～T8时 SBP 和DBP 明显升高（P＜0.05或 P＜0.01）。结论全麻麻醉诱导时辅用右美托咪定不仅可减轻气管插管反应，而且可增强麻黄碱的升压反应。

Objective To observe the effect of general anesthesia induction assisted dexme-detomidine on blood pressure responses to ephedrine.Methods Forty-four patients scheduled for lap-aroscopic cholecystectomy were randomly divided into normal saline（group N）and dexmedetomidine （group D）group.Group D was treated 15 minutes by micro pump injecting the dose of 0.8 μg/kg dexmedetomidine before anesthesia induction.Then the rate was changed to 0.4 μg·kg^-1 ·h^-1 and maintained.Meanwhile patients were given anesthesia induction and trachea intubation.0.1 mg/kg ephedrine was injected 5 minutes after trachea intubation.Likewise group N was treated 15 minutes by micro pump injecting physiological saline before anesthesia induction.The other treatments were same.SBP,DBP and HR were recorded before micro pump injecting dexmedetomidine or physiologi-cal saline（T0 ）,before anesthesia induction（T1 ）,during trachea intubation（T2 ）,2 min after trachea intubation（T3 ）,during ephedrine injection（T4 ）,2 min,5 min,10 min and 15 min after ephedrine （T5 ,T6 ,T7 ,T8 ）.Results Compared with T0 ,SBP and DBP of group N was lower at T1 ,T3-T8 but SBP,DBP and HR was higher at T2 （P〈0.05 or P〈0.01）.HR of group N was lower at T4 ,T7 and T8 （P〈0.05 or P〈0.01）.SBP at T1-T8 ,DBP at T1-T4 and T8 ,HR at T1 and T3 ,T4 was lower in group D（P〈0.05 or P〈0.01）.Compared with T2 ,SBP,DBP and HR of group N was lower at T3 and T4 （P〈0.01）.SBP of group D was lower at T4 （P〈0.01）.Compared with T4 ,SBP of group N was only higher at T5 and T6 （P〈0.05 or P〈0.01）.SBP,DBP and HR of group D were higher at T5-T7 and SBP was kept higher until T8 （P 〈0.01）.Compared with group N,HR of group D was lower at T1-T3 （P〈0.05 or P〈0.01）,SBP,DBP was lower at T2 （P 〈0.01）and was kept higher from T5 to T8 （P〈0.05 or P〈0.01）.Conclusion Intubation stress response will be relieved during anesthesia induction with dexmedetomidine,which can amplified ephedrine effect.