盐酸右美托咪定预先给药对子宫内膜癌合并高血压患者麻醉诱导期的影响

Effects of dexmedetomidine premedication on endometrial cancer patients with hypertention during general anesthesia induction

目的观察麻醉诱导前预输注盐酸右美托咪定对子宫内膜癌合并高血压患者麻醉诱导期血流动力学的影响,为右美托咪定的用药及效果提供依据。方法选择2013-02-01-2014-02-20我院行择期妇科子宫内膜癌手术患者42例,ASAⅠ-Ⅱ级,所有患者均有原发性高血压史,并且机体生理状态符合全身麻醉要求。42例患者随机分为右美托咪定组（D组,n=21）和对照组（C组,n=21）。两组患者入室后连续监测生命体征,均采用常规全凭静脉麻醉,D组于麻醉诱导前15min静脉微量泵注盐酸右美托咪定0.5μg/kg,C组于麻醉诱导前15min静脉微量泵生理盐水10mL。记录入手术室后15min时（T0）、诱导前（T1）、诱导后即刻（T2）、插管后1 min（T3）、插管后3 min（T4）、插管后5 min（T5）时的收缩压（SBP）、舒张压（DBP）和心率（HR）。采用SPSS 19.0统计软件进行分析。结果C组与D组平均SBP,T0时为（154.81±16.63）和（150.81±11.50）mm Hg,T1时为（147.10±20.93）和（152.48±11.22）mm Hg,T2时为（102.14±13.24）和（128.86±11.34）mm Hg,T3时为（131.81±19.98）和（138.43±12.88）mm Hg,T4时为（127.57±19.19）和（133.81±15.16）mm Hg,T5时为（126.57±13.06）和（138.67±10.52）mm Hg;C组与D组平均DBP,T0时为（90.19±8.21）和（89.19±9.94）mm Hg,T1时为（86.52±12.55）和（89.43±8.93）mm Hg,T2时为（59.33±9.64）和（68.43±8.23）mm Hg,T3时为（77.57±11.34）和（80.57±10.21）mm Hg,T4时为（77.86±10.46）和（78.05±10.01）mm Hg,T5时为（77.19±8.12）和（80.00±7.48）mm Hg。与T0比较,T1时D组SBP和DBP均小幅度增高。T2时两组的SBP和DBP均降低,P〈0.05,D组的降低幅度较C组小。T3-T5时气管插管后,两组SBP、DBP和HR均较T2时升高,但D组升高的幅度小于C组。C组与D组平均HR,T0时为76.38±11.40和78.05±10.49,T1时为78.05±10.67和69.76±8.45,T2时为69.33±11.50和67.05±7.87,T3时为77.52±10.75和70.62±6.97,T4时为76.19±11.10和65.38±15.72,T5时为72.19±10.26和66.19±4.73,D组T1的HR低于T0,P〈0.05;C组T3-T5的HR明显高于D组,P〈0.05。结论盐酸右美托咪定预先给药能明显减轻子宫内膜癌合并高血压患者麻醉诱导期的心血管反应,能够抑制全麻诱导期出现的血压下降,同时减弱气管插管引起的心血管应激反应,并且维持麻醉诱导及气管插管期间血流动力学的稳定。

OBJECTIVE To investigate the effects of dexmedetomidine premedication on endometrial cancer patients with hypertention during general anesthesia induction and provide the basis for the medication and effects of dexmedetomi- dine. METHODS Forty-two endometrial cancer patients who given gynecological surgery, ASA Ⅰ-Ⅱ grade were chosen and all the patients had history of essential hypertension whose physiological state was well to accept general anesthesia. Forty-two patients undergoing elective surgery were randomly assigned to：dexmedetomidine group （group D, n = 21） and control group （group C, n=21）. In the operating theater, two groups of patients were connected to standard basic monitoring and given conventional intravenous anesthesia. For patients of group D, dexmedetomidine 0. 5 μg/kg was given 15 min before the induction of anesthesia. For patients of group C saline 10 mL was given 15 min before the induction of anesthesia. SBP, DBP and HR were recorded on 15min after entered the operating room （T0）, before induction （T1）, immediately after induction （T2）, 1 min after intubation （T3）, 3 min after intubation （T4）, 5 min after intubation （T5）. Statistical analysis and graphs were done with SPSS 19.0. RESULTS The mean SBP of group C and group D were 154.81 ±16.63 and 150.81± 11.50, 147. 10±20.93 and 152.48 ± 11.22, 102. 14± 13.24 and 128.86± 11.34, 131.81±19.98 and 138. 43±12.88,127.57±19.19 and 133.81±15.16,126.57±13.06 and 138.67±10.52 at T0,T1, T2,T3,T4 and TS, respectively. The mean DBP of group C and group D were 90.19±8.21 and 89.19±9.94, 86.52±12.55 and 89.43±8.93, 59.33±9.64 and 68.43±8.23, 77.57±11.34 and 80.57±10.21, 77.86±10.46 and 78. 05± 10.01,77.19±8.12 and 80. 00±7.48 on T0,T1,T2,T3,T4 and T5, respectively. Comparison with TO, the SBP and DBP of group D were increased on T1 （P〈0.05）. Two groups of SBP, DBP were decreased on T2 （P〈0.05）, the reduction of group D was less. On T3-T5, after the tracheal intubation, SBP, DBP and HR of two groups were increased than that in T2, but group D was less. The mean HR of group C and group D were 76.38± 11.40 and 78.05±10.49, 78.05±10.67 and 69.76±8.45, 69.33±11.50 and 67.05±7.87, 77.52±10.75 and 70.62±6.97, 76.19±11.10 and 65. 38±15.72, 72.19±10. 26 and 66.19±4.73 onT0,T1,T2,T3,T4 andT5 respectively. OnT1, HR of group D was lower than that of T0 （P〈0.05）. On T3-T5, HR of group C was significantly higher than that of group D （P〈0.05）. CONCLUSIONS Dexmedetomidine premedication can significantly reduce cardiovascular response in endometrial cancer patients with hypertension during the induction of anesthesia. It can inhibit the drop of blood pressure in the induction of general anesthesia, reduce the extent of the stress response caused by endotracheal intubation, maintain stable hemodynamics in patients during induction and intubation.