右美托咪定抑制气管插管致血浆儿茶酚胺释放的有效剂量

Effective dose of dexmedetomidine in inhibiting release of plasma catecholamines induced by tracheal intubation

目的：探讨右美托咪定抑制气管插管致血浆儿茶酚胺释放的有效剂量。方法选择全身麻醉下择期行腹部手术的患者60例，随机均分为四组。麻醉诱导前，D1、D2和D3组分别予右美托咪定0.25、0.50和0.75μg／kg静脉泵注15 min ，C组予等体积生理盐水作为对照。麻醉诱导采用丙泊酚、雷米芬太尼和顺式阿曲库铵，脑电双频指数在40～50时行气管插管。记录输注右美托咪定前（T0）、诱导后（T1）、气管插管后即刻（T2）和气管插管后3 min（T3）、5 min（T4）、10 min（T5）时各组BP、HR、血浆去甲肾上腺素（NE）和肾上腺素（E）浓度。结果与 T0时比较，T1时C组和D1组BP降低，D1、D2、D3组 HR降低，T2～ T4时C组和D1组血浆 E浓度升高（P＜0．05），各时间点D2、D3组血浆E浓度均无明显变化（P＞0．05）。与T1时比较，T2～ T4时C组和D1组BP和 HR升高（P＜0．05）。四组各时点血浆NE浓度差异均无统计学意义（P＞0．05）。结论麻醉诱导前给予右美托咪定剂量达0.50μg／kg时即可有效抑制气管插管导致的血浆儿茶酚胺释放。

Objective To investigate the effective dose of dexmedetomidine in inhibiting the release of plasma catecholamines induced by tracheal intubation .Methods Sixty patients scheduled for abdominal surgery under general anesthesia were randomly and equally divided into 4 groups .Before anesthesia induction ,the patients in groups of D1 ,D2 and D3 were given intravenous infusion of dexmedetomidine 0.25 ,0.50 and 0.75 μg/kg within 15 minutes ,respectively ,and those in group C received same volume of normal saline as the controls .Anesthesia in 4 groups was induced with propofol ,remifentanil and atracurium ,and then tracheal intubation was performed when BIS value was maintained at 40-50 .BP ,HR and plasma concentrations of norepinephrine and epinephrine were recorded before infusion of dexmedetomidine （T0 ） ,after induction （T1 ） ,immediately after tracheal intubation（T2） and at 3 minutes（T3） ,5 minutes（T4） and 10 minutes（T5） after intubation .Results Compared with T0 ,BP was decreased in groups of C and D1 and HR was decreased in groups of D1 , D2 and D3 at T1 ,and plasma concentration of epinephrine was increased in groups of C and D1 at T2-T4（P〈0 .05） ,which was not significantly changed in groups of D2 and D3 at each time point （P〉0 .05） .Compared with T1 ,BP and HR were increased in groups of C and D1 at T2-T4 （P〈0 .05） .There was no significant difference in plasma concentration of norepinephrine among four groups at each time point （P〉0 .05） .Conclusion Intravenous infusion of dexmedetomidine 0.50μg/kg before anesthesia induction can effectively inhibit the release of plasma catecholamines induced by tracheal intubation .