右美托咪定对妇科手术患者围术期应激反应的影响及剂量学研究

Study on the effect of dexmedetomidine on perioperative stress reactions in patients undergoing gynecological surgery and dosimetry

目的探讨不同右美托咪定用法对妇科手术患者围手术期应激反应的影响。方法研究对象源于我院2013年10月至2014年10月收治的87例妇科手术患者，按随机数字表法分为空白组（29例）、对照组（29例）和观察组（29例）。空白组患者行常规麻醉诱导；对照组患者于麻醉诱导插管前给予右美托咪定1．0μg／kg，并以0．4μg／（kg·min）持续静脉泵入；观察组于麻醉诱导插管前15min静脉注射右美托咪定0．5μg／kg。统计三组患者术前、术中、术后去甲肾上腺素（NE）、。肾上腺素（E）浓度以及血糖水平（Glu），观察三组患者不良反应发生情况。结果术后，对照组和观察组患者NE、E、Glu水平分别升至（275．2±23．3）pg／ml、（153．7±17．6）pg／ml、（9．7±3．2）mmol/L和（193．6±19．7）pg／ml、（103．5±18．9）pg／ml、（6．3±1．5）mmol／L，两组上述指标组间比较差异有统计学意义（P〈0．05），且与本组术前、术中和空白组术后比较差异均有统计学意义（P〈0．05）。空白组、对照组及观察组患者不良反应发生率分别为20．7％、13．8％和10．3％，三组间比较差异无统计学意义（x2=1．375，P〉0．05）。结论右美托咪定能有效减少妇科手术患者围术期应激反应，且用药剂量为0．5μg／kg时患者应激反应最小，安全性良好。

Objective To investigate the effect of different usage of dexmedetomidine on perioperative stress reactions in patients undergoing gynecological surgery. Methods 87 patients undergoing gynecological surgery in our hospital from October 2013 to October 2014 were selected and randomly divided into blank group （29 cases）, control group （29 cases）, and observation group （29 cases） according to the random number table method. Patients in blank group were treated with routine anesthesia induction; patients in control group were treated with dexmedetomidine 1.0μg/kg and continuous intravenous infusion of 0.4μg/（kgomin） before anesthesia induced intubation; patients in observation group were treated with intravenous injection of dexmedetomidine 0.5μg/kg in 15 rain before anesthesia induced intubation. Preoperative, intraoperative and postoperative norepinephrine （NE）, epinephrine （E） concentrations and blood glucose （Glu） level in three groups were statistically analyzed. The incidence of adverse reactions in three groups were observed. Results After operation, the levels of NE, E, and Glu in control group and observation group increased to （275.2±23.3）pg/ml, （153.7±17.6）pg/ml, （9.7±3.2） mmol/L and （193.6±19.7）pg/ml, （103.5± 18.9）pg/ml, （6.3± 1.5） mmol/L respectively; there were statisticallysignificant differences in indexes mentioned above between two groups （P〈0.05）, with statistically significant differences compared with those before and during operation in the same group, and those in blank group after operation （P〈0.05）. The incidence of adverse reactions in blank group, control group, and observation group were 20.7%, 13.8%, and 10.3%, without statistically significant difference among three groups （X 2=1.375, P〉0.05）. Conclusion Dexmedetomidine can effectively reduce stress reactions in patients undergoing gynecological surgery, and stress reactions in patients are the minimum when the dosage is 0.51μg/kg, with good safety.