右美托咪定对气管内全麻诱导期血流动力学及应激反应的影响

The influence of dexmedetomidine on hemodynamics and stress reaction during endotracheal general anesthesia induction period

目的:探讨分析不同剂量右美托咪定对气管内全麻诱导期血流动力学及应激反应的影响。方法:选择拟在全麻下行外科手术患者90例,ASAⅠ或Ⅱ级,年龄40~60岁。随机均分为3组:右美托咪定0.5μg/kg组(A组)、右美托咪定0.75μg/kg组(B组)、对照组(C组)。A组和B组分别泵注右美托咪定0.5和0.75μg/kg,C组不进行任何处置。3组患者都在泵注结束以后进行全麻诱导。分别记录麻醉给药前(T_0)、给药后3min(T_1)、插管后1min(T_2)、插管后3min(T_3)、插管后10min(T_4)各时间点患者的平均动脉压(MAP)和心率(HR),并于T_0、T_2及T_43个时间点取血,检测血糖及皮质醇浓度,对比分析各个时间节点患者状态。结果:(1)血流动力学:A、B、C组部分时间点平均动脉压、心率较T_0有所改变,差异有统计学意义;C组与A、B组间部分时点平均动脉压、心率差异有统计学意义(P<0.05)。(2)与T_0时比较,T_2和T_4两个时间点,三个组的Glu、Cor浓度显著增加(P<0.05),并以T_4时升高最为显著,但与C组相比较,A和B组明显降低(P<0.05)。结论:右美托咪定可降低麻醉操作引起的应激反应,维护血流动力学的稳定,有利于保证患者的麻醉手术安全。

Objective: To discuss and analyze the influence of dexmedetomidine of different doses on hemodynamics and the stress reaction during endotracheal general anesthesia induction period. Methods: 90 patients were chosen to have a surgery with a general anesthesia,and they are ASAⅠ or Ⅱ level,and their ages were from 40 to 60 years old. The patients were randomly divided into three groups: dexmedetomidine 0. 5μg/kg group( Group A),dexmedetomidine 0. 75μg/kg group( Group B),control group( Group C). The patients in group A and group B are respectively injected with dexmedetomidine for 0. 5 and 0. 75μg/kg( it is diluted with saline to 20 m L),and the injection were completed within 15 minutes; The patients in group C weren't disposed. After finishing the injection,the patients in the three groups were began to implement a general anesthesia induction. Through analyzing the observational index of five time points,this study got the experimental conclusions. It respectively recorded the patients' mean arterial pressure( MAP) and heart rate( HR) before giving anesthesia drug( T_0),3 minutes after taking the drug( T_1),1 minute after intubation( T_2),3 minutes after intubation( T_3),10 minutes after intubation( T_4),and took blood at T_0,T_2 and T_4,and then it detected blood sugar and cortisol concentration,so as to contrast and analyze patients' state at each time node. Results:(1)Blood flow dynamics: the mean arterial pressure and heart rate of patients in group A,B and C at part time points changed,and the difference had a statistical significance; There is a difference of mean arterial pressure and heart rate at some time points between group C and group A,group B,and the difference had a statistical significance( P < 0. 05).(2)Compared with T0,the concentration of Glu and Cor at T_2 and T_4 in three groups increased significantly( P < 0. 05),and the increase at T_4 was most significant,but compared with group C,the concentration of Glu and Cor in group A and group B was significantly decreased( P < 0. 05). Conclusion: Dexmedetomidine can reduce the stress reaction caused by anesthesia operation and maintain the stability of hemodynamics,and it is beneficial for ensuring patients' safety of anesthesia surgery.