右美托咪定对腹腔镜子宫切除术患者血流动力学及应激反应的影响

Effect of Dexmedetomidine on Hemodynamics and Stress Reactions of Laparoscopic Hysterectomy Patients

目的:探讨右美托咪定(Dex)对腹腔镜子宫切除术患者血流动力学及应激反应的影响。方法:选择2012年7月到2014年7月在我院行腹腔镜子宫切除术的36例患者,随机分为实验组和对照组各18例。实验组静脉注射Dex 1μg/kg直到手术结束,对照组同法给予生理盐水。于麻醉前15 min(T0)、插管后5 min(T1)、气腹后20 min(T2)、术后立刻(T3)和术后24 h(T4)四个时间点,分别监测其平均动脉压(MAP)、心率(HR),并测定血浆皮质醇(Cor)、去甲肾上腺素(NE)和白细胞介素6(IL-6)水平。结果:T0时两组患者的MAP和HR比较,无显著性差异(P>0.05),对照组T1、T2、T3时明显升高(P<0.05),实验组轻微升高,两组相比差异有显著性(P<0.05)。T4时两组患者的MAP和HR均恢复至正常水平。T0时两组Cor、NE和IL-6比较,无显著性差异(P>0.05),对照组T2、T3、T4时明显升高(P<0.05),实验组轻微升高,两组相比差异有显著性(P<0.05)。T4时除NE,其他指标均达到峰值。结论:Dex能维持围术期患者血流动力学稳定,降低术中的应激反应。

Objective： To observe the effect of Dexmedetomidine（Dex） on hemodynamics and stress reactions of the laparoscopic hysterectomy patients. Methods： A total of 36 patients, who underwent laparoscopic hysterectomy in Pudong Hospital Affiliated to Fudan University during Octomber 2012 to Octomber 2014, were selected and randomly divided into experiment group（n=18） and control group（n=18）. The experimental group was intravenously injected with 1 μg/kg Dex until the end of surgery, and the control group, with normal saline. Mean artery pressure（MAP）, heartrate（HR）, the levels of cortisol（Cor）, norepinephrine（NE） and interleukins-6（IL-6）were recorded 15 min before giving Dexmedetomidine infusion（T0）, 5 min after tracheal intubation（T1）, 20 min after skin incision（T2）,immediately after surgery（T3） and 24 h after surgery（T4）. Results： At the time of T0, there was no significant difference in the MAP and HR of the two groups（P〉0.05）, but the MAP and HR of control group were significantly higher at T1, T2, T3（P〈0.05）, the MAP and HR of experimental group were slightly elevated, there were significant differences between the two groups（P〈0.05）. The MAP and HR of the two groups resumed to normal levels at the time of T4. There was no significant difference in the Cor, NE and IL-6 of the two groups at the time of T0.（P〉0.05）, but the Cor, NE and IL-6 of control group significantly increased at T2, T3, T4（P〈0.05）, the Cor, NE and IL-6 of experimental group were slightly elevated, there were significant differences between the two groups（P〈0.05）. The other indexes of the two groups arrived to peak excepting NE. Conclusion： Dex can maintain the hemodynamic stability of surgical patients,and reduce the patients＇ stress response.