右美托咪定对不同类型垂体肿瘤切除术患者血流动力学的影响

Effect of dexmedetomidine on intraoperative hemodynamics during transsphenoidal resection of the pituitary adenoma

目的观察右美托咪定对不同类型垂体肿瘤切除术患者血流动力学的影响。方法回顾分析北京协和医院2013年8月至11月接受经鼻-蝶窦垂体肿瘤切除术的患者60例,分为右美托咪定组(D组)24例,对照组(C组)36例,右美托咪定组患者麻醉诱导后静脉持续泵注右美托咪定0.5μg·kg-1·h-1,直至手术结束;对照组接受常规全身麻醉。进一步分析右美托咪定对垂体无功能腺瘤切除术患者血流动力学的影响。记录麻醉前(术前)、切除垂体腺瘤期间(术中)及在麻醉恢复室苏醒期(术后)的SBP、DBP和HR的最高值(max)与最低值(min);术前、术后WBC、Hb、Plt的变化;术前与术后体温,术中芬太尼用量、手术时间、苏醒时间、住院天数等。结果与C组比较,D组患者术中SBPmax,术后SBPmax、SBPmin均明显降低,HRmax明显减慢(P<0.05);垂体无功能腺瘤患者术中SBPmax,术后苏醒期SBPmax、SBPmin、DBPmax、DBPmin明显降低,HRmax明显减慢(P<0.05)。术中应用右美托咪定对生长激素腺瘤或库欣病腺瘤患者术中及术后血流动力学指标无明显影响。两组患者术中芬太尼用量、手术时间、苏醒时间、住院天数以及术前术后体温、外周血WBC、Hb与Plt等差异均无统计学意义。结论术中持续输注右美托咪定0.5μg·kg-1·h-1有助于维持术中、术后苏醒期血流动力学平稳,尤其对于垂体无功能腺瘤患者更具有临床意义。

Objective To investigate the effect of dexrnedetomidine on intraoperative hemody- namics during transsphenoidal resection of the pituitary adenoma. Methods A total numbers of 60 pa- tients from August to November 2013, who were admitted into Peking Union Medical College Hospi- tal for elective trans-sphenoidal resection of pituitary adenoma, were retrospectively chosen for com- parison. Among them, twenty-four patients were infused with dexmedetomidine 0.5μg · kg^-1 · h^-1 during the operation, with the other thirty-six patients were without dexmedetomidine infusion as the control. Either the maximal or the minimal data of SBP, DBP and HR during the preoperative, in trao- perative and postoperative periods were recorded. Besides, changes of WBC, Hb, Plt and body tempera- ture were recorded, together with does of hypnotics and narcotics during surgery, duration of surgery and anesthesia, length of stay in PACU and hospital. Results intraoperative SBPmax and PACU SB- Pmax, SBPmin, HRmax were significantly lower in Dex group compare to control group （P〈0. 05）. For non-function pituitary adenoma patients, intraoperative SBPmax and PACU SBPmax, SBPmin, DBPmax, DBPmin, HRmax were significantly lower in Dex group compare to control group （P〈 0. 05）. For Cushing syndrome or Growth hormone secretory pituitary adenoma patients, dexmedeto- midine had no effect on intraoperative hemodynamies during transsphenoidal resection. No significance were found in Dex group compare to control group on WBC, Hh, Plt and body temperature were re- corded, together with dose of hypnotics and narcotics during surgery, duration of surgery and anes- thesia, length of stay in PACU and hospital. Conclusion Dexmedetomidine infusion （0. 5 μg· kg^-1 · h^-1） could stabilize the intraoperative hemodynamics for non-function pituitary adenoma patients.