右美托咪定对微创McKeown食管癌根治术患者术中尿量的影响

Influence of dexmedetomidine on urinary volume of patients undergoing Mc Keown minimally invasive esophagectomy

目的探讨右美托咪定（Dex）对微创McKeown食管癌根治术患者术中尿量的影响及其机制。方法择期行微创McKeown食管癌根治术的患者60例（ASAⅠ～Ⅱ级），随机分为3组，每组20例。Dex1组、Dex2组麻醉诱导前，予Dex1μg·kg-1静脉泵注，15min泵完，后以0．2、0．4μg·kg-1·h-1维持至手术结束；对照组予等量氯化钠注射液静脉泵注。术中监测患者生命体征。记录每小时尿量，采用放射免疫法测定6个时点（术前，术中1、2、3h，术毕，术后2h）血浆抗利尿激素（ADH）、醛固酮（ALD）、心房钠尿肽（ANP）浓度。结果Dex1组、Dex2组患者尿量从术中2h开始增高，且Dex2组增高程度高于Dex1组（P〈0．05）。3组血浆ADH浓度围术期均无明显变化，术中1hDex1组、Dex2组血浆ALD浓度开始下降，低于术前和对照组（P〈0．05），Dex1组、Dex2组间各时点无显著差异（P〉0．05）。Dex1组、Dex2组血浆ANP浓度从术中1h起增高，术中3h达高峰，术中各时点均高于对照组（P〈0．05），两组之间各时点均无显著差异（P〉0．05）。结论Dex应用于微创McKeown食管癌根治术患者具有利尿作用．可能通过抑制肾素-血管紧张素-醛固酮系统和增加ANP释放使患者尿量增加。

AIM To investgate the influence of dexmedetomidine （Dex） on urinary volume of patients undergoing McKeown minimally invasive esophagectomy and to explore its mechanism. METHODS Sixty ASA Ⅰ - Ⅱ patients scheduled for McKeown minimally invasive esophagectomy were randomly assigned into 3 groups： control group （group C）, group Dexl and Dex2, with 20 patients in each group. Before induction, Dex 1 μg. kg-1 was injected by continuous intravenous pumping in 15 min, then respectively following by 0.2 and 0.4 μg. kg-1.h-1 to the end of surgery in the group Dexl and Dex2. The patients in the group C were administrated the same amount of chloride sodium injection by intravenous injection pumping. Patients＇ vital signs, invasive blood pressure, central venous pressure were monitored. Urine volume per hour during operation was recorded. The plasma concentrations of antidiuretic hormone （ADH）, were measured with radioimmunityassay at the six time aldosterone （ALD）, atrial natriuretic peptide （ANP） points （before operation, the first, second, third hour of operation and 2 h after operation）. RESULTS The urine volume of patients in the group Dexl and Dex2 begun to increase, which was higher than that of the group C from the second hour of operation, and more obvious in group Dex2 than group Dexl （P 〈 0.05）. The concentrations of ADH in 3 groups had no statistical differences during the operation. The concentration of ALD in the group Dexl and Dex2 begun to decrease from the first hour and was lower than that of the group C （P 〈 0.05）. The concentration of ALD had no statistical difference between the group Dexl and Dex2 （P 〉 0.05）. The concentration of ANP in the group Dexl and Dex2 begun to increase from the first hour of the operation, and reached to the peak at the third hour, higher than that of the group C （P 〈 0.05）. The concentration of ANP had no statistically significant difference between group Dexl and group Dex2 at each point （P 〈 0.05）. CONCLUSION Dex has diuretic effect in McKeown minimally invasive esophagectomy probably by inhibiting renin-angiotensin-aldosterone system and increasing the release of ANP.