盐酸右美托咪定对ICU患者气管插管应激反应的影响

Effect of dexmedetomidine on stress response during tracheal intubation in patients with ICU

目的探讨盐酸右美托咪定对ICU患者气管插管应激性反应的影响。方法选取解放军昆明总医院2015年1月—2016年1月ICU病房收治的危重症患者76例作为研究对象,按随机数字表法分为对照组和观察组,每组38例,两组均于气管插管前进行桡动脉穿刺,并建立静脉通道,观察组静脉泵注盐酸右美托咪定0.5μg/kg,持续10 min,对照组静脉泵注等量生理盐水,随后两组均静脉滴注适量顺-阿曲库铵和丙泊酚。观察两组麻醉用药剂量;检测两组插管前(T_1)、插管后(T_2)、插管后3 min(T_3)及插管后5 min(T_4)时刻患者动脉压(MAP)、心率(HR)、血浆皮质酮水平的变化。结果两组丙泊酚、顺-阿曲库铵麻醉用药剂量比较差异不显著;观察组T_3、T_4时刻MAP、HR、血浆皮质酮水平均显著低于对照组(P<0.05)。结论在ICU患者气管插管中应用盐酸右美托咪定可维持血浆皮质醇水平、血流动力学稳定。

Objective To investigate the effect of dexmedetomidine on tracheal intubation in patients with ICU. Methods A totalof 76 severe cases of patients treated in ICU of Kunming General Hospital of Chinese PLA from January 2015 to January 2016 wereselected as the subjects, randomly divided into control and observation groups, 38 cases in each group. The two groups underwentradial artery puncture before the trachea intubation, and the venous passage was established. The observation group received ivinfusion of dexmedetomidine hydrochloride （0.5 g/kg） for 10 min, and the control group received iv injection of normal saline. Thenthe two groups were given iv infusion of appropriate atracurium and propofol. The anesthesia dosages of two groups were observed;The levels of angiosthenia （MAP）, heart rate （HR） and plasma corticosterone were detected before intubation （T1）, after intubation（T2）, 3 rain after intubation （T3） and 5 min after intubation （T4） in two groups. Results Propofol and CIS atracurium anesthesia doseof the two groups had no significant difference. The levels of MAP, HR and plasma corticosterone in observation group weresignificantly lower than those in the control group at T4 and T3 time （P 〈 0.05）. Conclusion Application of dexmedetomidineanesthesia could reduce the stress response in patients with endotracheal intubation in ICU and maintain stable hemodynamics andplasma corticosterone.