右美托咪定注射液用于气管插管全身麻醉围手术期的临床研究

Clinical trial of dexmedetomidine injection for perioperative period patients after tracheal intubation under general anesthesia

目的观察不同剂量右美托咪定注射液用于气管插管全身麻醉围手术期的临床疗效及安全性。方法将60例气管插管全身麻醉围手术期患者随机分为对照组20例、试验A组20例和试验B组20例。麻醉诱导前10 min,对照组予以0.9%Na Cl注射液20 m L,静脉泵注;试验A组予以右美托咪定0.5μg·kg-1,静脉泵注;试验B组予以右美托咪定0.8μg·kg-1,静脉泵注。比较3组患者注射右美托咪定前(T_0)、插管前(T_1)、插管1 min后(T_2)、插管3min后(T_3)的心率(HR)、平均动脉压(MAP)水平,T_0、T_3时刻血清肾上腺素(AD)、去甲肾上腺素(NA)水平,以及药物不良反应的发生情况。结果在T_1、T_2、T_3时间点,对照组的HR分别为(72.98±9.45),(91.47±1.37),(89.75±8.37)次/分,试验A组的HR分别为(61.75±7.59),(67.48±8.47),(66.64±8.23)次/分;试验B组的HR分别为(61.24±7.84),(66.94±8.38),(66.88±8.05)次/分;对照组的MAP分别为(97.27±9.58),(115.63±11.56),(109.56±9.73)mm Hg,试验A组的MAP分别为(78.75±8.67),(89.46±10.82),(87.68±8.97)mm Hg;试验B组的MAP分别为(77.94±8.53),(87.56±10.32),(85.54±8.13)mm Hg,试验A、B组与对照组比较差异均有统计学意义(P<0.05),但试验A组与B组比较差异均无统计学意义(P>0.05)。在T3时间点,对照组与试验A、B组的血清AD分别为(0.81±0.09),(0.52±0.07),(0.49±0.06)nmol·L^(-1),NA水平分别为(5.83±0.82),(3.92±0.55),(3.88±0.51)nmol·L^(-1)。对照组与试验A、B组比较差异均有统计学意义(P<0.05),试验A组与试验B组比较差异均无统计学意义(P>0.05)。对照组和试验A组均未发生药物不良反应,试验B组发生的药物不良反应主要有心动过缓和低氧血症。与对照组和试验A组的0相比,试验B组的药物不良反应发生率为25.00%,差异有统计学意义(P<0.05)。结论 0.5μg·kg-1右美托咪定能显著降低气管插管全身麻醉围手术期患者的HR、MAP,以及血清AD、NA水平,且安全性较高。

Objective To observe the clinical efficacy and safety of different doses of dexmedetomidine injection for perioperative period patients after tracheal intubation under general anesthesia. Methods Sixty perioperative patients with tracheal intubation under general anesthesia were randomly divided into control group, treatment A group and treatment B group with 20 cases per group. Before 10 min induction of anesthesia,control group was given 0. 9% Na Cl 20 m L,intravenousinfusion; treatment A and B groups were given 0. 5,0. 8 μg·kg^-1dexmedetomidine,intravenous infusion,respectively.The levels of heart rate（ HR）,mean arterial pressure（ MAP） before injection of dexmedetomidine（ T0）,before intubation（ T1）,1 min after intubation（ T2）,3 min after intubation（ T3）,the levels of serum adrenalin（ AD） and noradrenalin（ NA） at T0,T3 and adverse drug reactions（ ADR） were compared between three groups. Results At T1,T2,T3,HR in control group were（ 72. 98 ± 9. 45）,（ 91. 47 ± 1. 37）,（ 89. 75 ± 8. 37） beat·min^（- 1）,HR in treatment A group were（ 61. 75 ± 7. 59）,（ 67. 48 ± 8. 47）,（ 66. 64 ± 8. 23） beat · min^-1HR in treatment B group were（ 61. 24 ± 7. 84）,（ 66. 94 ± 8. 38）,（ 66. 88 ± 8. 05） beat · min- 1; MAP in control group were（ 97. 27 ± 9. 58）,（ 115. 63 ± 11. 56）,（ 109. 56 ± 9. 73） mm Hg,MAP in treatment A group were（ 78. 75 ± 8. 67）,（ 89. 46 ± 10. 82）,（ 87. 68 ± 8. 97） mm Hg,MAP in treatment B group were（ 77. 94 ± 8. 53）,（ 87. 56 ± 10. 32）,（ 85. 54 ± 8. 13） mm Hg;At T3,AD in control,treatment A,treatment B groups were（ 0. 81 ± 0. 09）,（ 0. 52 ± 0. 07）,（ 0. 49 ± 0. 06）nmol·L^-1NA（ 5. 83 ± 0. 82）,（ 3. 92 ± 0. 55）,（ 3. 88 ± 0. 51） nmol ·L^-1 The differences were statistically significant between treatment group A,B groups and control group（ P〈0. 05）,and without significant difference between treatment A group and treatment B group（ P〉0. 05）. There were no ADRs occurred in control group and treatment A group,but the ADRs in treatment B group were based on bradycardia and hypoxemia. The incidences of ADRs in control,treatment A,B groups were 0,0,25. 00%,with significant difference between control,treatment A groups and treatment B group. Conclusion Dexmedetomidine at 0. 5 μg·kg^-1can reduce the levels of HR,MAP,AD,NA in perioperative patients with tracheal intubation under general anesthesia,which is safe.