右美托咪定对脊柱骨折患者围手术期应激反应的影响

Effect of dexmedetomidine hydrochloride on perioperative stress response in the patients with spinal fracture

目的探讨右美托咪定对脊柱骨折患者围手术期应激反应的影响。方法选择暨南大学第二临床医学院于2014年6月至2017年4月期间收治的76例脊柱骨折患者为研究对象,根据随机数表法将患者分为观察组与对照组,每组38例,对照组采用丙泊酚维持麻醉,观察组则应用右美托咪定麻醉,比较两组患者麻醉诱导前(T0)、气管插管完成时(T1)、手术进行1 h(T2)、手术结束时(T3)以及气管插管拔管时(T4)的平均动脉压(MAP)、心率(HR)水平及血浆肾上腺素(Adr)及皮质醇(Cor)水平。结果 T1、T4时点,两组患者的MAP、HR均高于T0,且观察组明显低于对照组,差异均有统计学意义(P<0.05);观察组患者血浆Adr、Cor水平在T1、T2、T4时点分别为(15.53±1.58)ng/L和(3.95±0.73)×10~3nmol/L,(15.73±1.45)ng/L和(4.37±0.94)×10~3nmol/L,(18.86±2.43)ng/L和(4.23±1.10)×10~3nmol/L,对照组分别为(17.95±1.42)ng/L和(4.64±1.21)×10~3nmol/L,(18.47±1.44)ng/L和(5.73±1.34)×10~3nmol/L,(22.74±3.27)ng/L和(5.13±1.37)×10~3nmol/L,两组患者的血浆Adr、Cor水平在T1、T2、T4时点均明显高于T0,且观察组低于对照组,差异均有统计学意义(P<0.05)。结论右美托咪啶用于脊柱骨折患者的手术麻醉,可以减轻患者围手术期的应激反应,对于保持血流动力学的稳定具有重要意义。

Objective To investigate the effect of dexmedetomidine hydrochloride on perioperative stress re-sponse in the patients with spinal fracture. Methods Seventy-six patients with spinal fractures who were treated in theSecond Clinical Medical College of Jinan University during June 2014 to April 2017 were selected as the research ob-jects. According to the random number table method, the patients were randomly divided into observation group and con-trol group, with 38 patients in each group. The control group was treated with propofol to maintain anesthesia, and theobservation group was given anesthesia with dexmedetomidine hydrochloride. The mean arterial pressure （MAP）, heartrate （HR）, the level of plasma epinephrine （Adr） and cortisol （Cor） before anesthesia induction （T0）, at tracheal intuba-tion （T1）, one hour of operation （T2）, the end of operation （T3） and extubation （T4） were compared between the twogroups. Results At T1, T4, MAP, HR in both groups were higher than T0, and the levels in the observation groupwas significantly lower than those in the control group （P〈0.05）; The serum Adr and Cor levels in the observation group atT1, T2, T4 time were （15.53±1.58） ng/L and （3.95±0.73）×103 nmol/L, （15.73±1.45） ng/L and （4.37±0.94）×103 nmol/L,（18.86±2.43） ng/L and （4.23±1.10）×103 nmol/L, and （17.95±1.42） ng/L and （4.64±1.21）×103 nmol/L,（18.47±1.44） ng/Land （5.73±1.34）×103 nmol/L, （22.74±3.27） ng/L and （5.13±1.37）×103 nmol/L in the control group, which were significantlyhigher than those at T0 in the two groups, and the levels in observation group were lower than those in the control group （P〈0.05）. Conclusion Dexmedetomidine hydrochloride anesthesia in patients with spinal fractures can relieve the stress re-sponse during perioperative period, which is important for maintaining the stability of hemodynamics.