右美托咪定对闭环麻醉下嗜铬细胞瘤切除患者术中血流动力学的影响研究

Effects of dexmedetomidine on hemodynamics under venous closed-loop anesthesia in pheochromocytoma resection

目的观察右美托咪定对闭环麻醉下嗜铬细胞瘤切除患者术中血流动力学的影响。方法选取嗜铬细胞瘤临床功能1级患者40例,分为右美托咪定组（n=20）于麻醉诱导前30min启动右美托咪定靶控输注,浓度设为3ng/mL,对照组（n=20）泵注等容量生理盐水。于丙泊酚闭合环反馈复合瑞芬太尼靶控输注麻醉下通过Swan-Gans漂浮导管监测术前基础值（T0）,气管插管时（T1）、切皮时（T2）、切除瘤体时（T3）、切除瘤体后5min（T4）、切除瘤体后10min（T5）、术毕（T6）的心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）、每搏指数（SI）、心排指数（CI）、肺动脉楔压（PCWP）、外周循环阻力指数（SVRI）和左室收缩功指数（LVSWI）。结果右美托咪定组在T1-T3的HR、MAP、SVRI和LVSWI均显著低于对照组（P〈0.05）,SI则高于对照组（P〉0.05）;而在T4-T5的SI、CI、PCWP及SVRI均显著低于对照组（P〈0.05）。结论右美托咪定能使闭环麻醉下嗜铬细胞瘤切除患者术中血流动力学更加稳定。

Objective To observe the effects of dexmedetomidine on hemodynamics under venous closed-loop anesthesia in pheochromocytoma resection.Methods Forty patients with clinical classification 1underwent pheochromocytoma,were randomly divided into 2groups：the dexmedetomidine group and the control group,20 patients in each group.30 minutes before the anesthesia induction,dexmedetomidine target controlled infusion system was started in Dexmedetomidine group with concentration of 3ng/mL.While patients in the control group was given the same volume of saline.At the closed loop feedback of propofol combined with remifentanil target controlled infusion anesthesia,through Swan-Gans catheter monitoring heart rate（HR）,mean arterial pressure（MAP）,central venous pressure（CVP）,stroke volume inDex（SI）,cardiac inDex（CI）,pulmonary artery wedge pressure（PCWP）,peripheral vascular resistance inDex（SVRI）and left ventricular work inDex（LVSWI）at the time of preoperative baseline（T0）,tracheal intubation（T1）,skin incision（T2）,resection of tumor body（T3）,5min after excision of the tumor（T4）,10 min after resection of the tumor（T5）,after operation（T6）.Results The HR,MAP,SVRI and LVSWI of Dex medetomidine group were significantly lower than those of the control group at T1 to T3（P0.05）,but SI was higher than that of the control group（P0.05）;while the SI,CI,PCWP and SVRI were significantly lower than those of the control group at T4 to T5（P0.05）.Conclusion Dexmedetomidine can maintain hemodynamics more stable under venous closed-loop anesthesia in pheochromocytoma resection.