不同时间点应用右美托咪定对患者围全麻诱导期血流动力学的影响分析

Influence of dexmedetomidine at different time-point on hemodynamics among patients undergoing general anesthesia

目的探讨不同时间点应用右美托咪定对患者围全麻诱导期血流动力学的影响,指导临床应用。方法选取衢州市人民医院2012年2月—2014年2月收治的上腹部全麻手术患者120例,采用随机数字表法将患者随机分为对照组、诱导前组、诱导时组、诱导后组,每组30例,对照组进行常规麻醉诱导,诱导前组、诱导时组及诱导后组分别在麻醉诱导前、麻醉诱导同时及麻醉诱导气管插管后静脉泵注盐酸右美托咪定0.6μg/kg,10 min泵注完成。采用单因素方差分析比较各组患者不同时间点的心率、收缩压、舒张压及药物干预情况。结果 T2时,各组患者的SBP、DBP均明显降低,T3时,各组患者的SBP、DBP均明显升高,T4～T6时,各组SBP、DBP逐渐下降。T2时,组间比较,诱导时组SBP,DBP明显高于其他3组（P〈0.05）。诱导前组SBP、DBP明显高于诱导后组和对照组。T6时,诱导后组的SBP、DBP明显高于其他3组（P〈0.05）,诱导前组和诱导时组SBP、DBP明显高于对照组。T8时,对照组SBP、DBP显著低于其他3组（P〈0.05）。T1时,诱导前组心率明显低于其余3组（P〈0.05）。T5～T8时间点,对照组患者HR明显高于其他3组（P〈0.05）,诱导前组,诱导时组与诱导后组患者之间没有明显差异。对照组使用心血管活性药物显著高于其他3组。结论右美托咪定可显著降低麻醉诱导造成的血压和心率波动。

Objective To investigate the influences of dexmedetomidine at different time-point on hemodynamics among patients undergoing general anesthesia and guide the clinical application of dexmedetomidine. Methods 120 patients undergoing general anesthesia for upper abdominal surgery in our hospital from February 2012 to February 2014 were randomly divided into control group （ Group C ）, before induction group （ Group BI）, induced group （ Group I ）, after the induction group （Group AI） according to the random number table ,30 cases in each group. Group C received routine anesthesia induction. Group BI, group I and group AI received intravenous infusion of dexmedetomidine hydrochloride 0.6 μg/kg, within 10 min respectively before induction of anesthesia, anesthesia induction and after anesthesia induction. Heart rates （HR）, systolic blood pressures（ SBP）, diastolic blood pressures （DBP） in different time and drug intervention were compared with one-way ANOVA. Results SBP and DBP decreased in each group at T2. SBP and DBP increased in each group at T3. SBP and DBP decreased gradually from T4 to T6. SBP and DBP in group I was significantly higher than that in other 3 groups at T2. SBP and DBP in group BI were significantly higher than that in group C and Group AI. SBP and DBP in group AI were significantly higher than that in other 3 groups at T6. SBP and DBP in group BI and group I were significantly higher than that in group C. SBP and DBP in group C were significantly lower than that in other 3 groups at TS. HR in group BI was significantly lower than that in other 3 groups at T1. HR in group C was significantly higher than that in other 3 groups at T5-TS. There was no difference among group BI, group I and group AI. The use of cardiovascular active drug in group C was significantly higher than that in other 3groups. Conclusion Dexmedetomidine can significantly decrease the blood pressure and heart rate fluctuations caused by anesthesia induction.