右美托咪定预先给药对高血压冠心病患者诱导插管时血流动力学及应激反应的影响

Effect of Dexmedetomidine Pretreatment on the Hemodynamics in Patients with Hypertension and Coronary Heart Disease During Induction of Anesthesia and Intubation

目的:探讨右美托咪定预先给药对高血压冠心病患者诱导插管时血流动力学及应激反应的影响。方法:将我院2012年7月-2013年3月择期行腹部手术且合并高血压冠心病患者50例随机均分为实验组(麻醉诱导前15 min静脉泵入剂量为1.0μg/kg的右美托咪定稀释液15 m L)和对照组(麻醉诱导前15 min静脉泵入15 m L生理盐水),监测并记录两组患者在不同时刻的BP、HR、RPP,抽取静脉血测定血浆NE和E的浓度。结果:(1)与T0时刻相比,对照组患者的心率、血压、RPP在T1-T5各时刻是先有所下降后又上升的(P<0.05),其中对照组RPP在T3时明显上升(P<0.01),然而实验组内在各时刻变化不明显(P>0.05),两组间比较差异具有统计学意义(P<0.05);(2)与T0时刻进行比较,对照组患者血浆NE和E的含量水平在T3、T4时刻明显上升(P<0.05),而实验组则变化不明显,组间比较差异具有统计学意义(P<0.05)。结论:右美托咪定预先给药用于缓解高血压冠心病患者诱导插管时心血管反应效果显著,值得临床推广应用。

Objective： To investigate the effects of dexmedetomidine pretreatment on the hemodynamics in patients with hyperten- sion and coronary heart disease during induction of anesthesia and intubation. Methods： 50 cases payients with hypertension and coro- nary heart disease scheduled for abdominal surgery in our hospital from July 2012 to March 2013 were divided into control group（C group） （intravenous infusion of normal saline 15 mL） and experimental group （E group） （intravenous infusion dose of 1.0 ixg/kg of dexmedetomidine given Diluent 15 mL）, the BP, HR, RPP at different times of patients were monitored, venous blood samples were ob- tained for analysis of norepinephrine and epinephrine levels at different times. Results： （1）Compared with TO, BP, HR and RPP were de- creased then increased from T1-T5 （P〈0.05） and RPP were significantly higher at T3 than those in control group （P〈0.01）, these above-mentioned variables had no significant differences in experimental group （P〉0.05）, there were significant differences between two groups （P〈0.05）; （2）The levels of NE and E were higher at T3-T4 than those at TO in control group（P〈0.05）, but there were no significant differences at these time points in experimental group（P〉0.05）, there were significant differences between two groups （P〈0.05）. Conclu- sion： Dexmedetomidine pretreatment has a significant effects on alleviating the cardiovascular-response in patients with hypertension and coronary heart disease during induction of anesthesia and intubation,which was worthy of clinical widely.