右美托咪定复合全麻对围术期应激反应的影响

Effects of Dexmedetomidine on Perioperative Stress Response in Combined General Anesthesia

目的探讨右美托咪定复合舒芬太尼靶控输注和七氟烷全麻对围术期应激反应的影响。方法 2017年8月～2018年1月择期全麻下腹腔镜手术40例(18～68岁,ASAⅠ或Ⅱ级),随机(信封法)分为观察组和对照组,每组20例。观察组麻醉诱导前静脉输注右美托咪定0.3μg/kg(10 min输注完成),对照组静脉输注等量生理盐水。麻醉诱导采用靶控输注舒芬太尼、丙泊酚和罗库溴铵静脉注射。麻醉维持采用靶控输注舒芬太尼复合吸入七氟烷,间断静脉注射罗库溴铵维持肌肉松弛。2组均用效应室浓度靶控输注和脑电双频谱指数(bispectral index,BIS)监测指导控制麻醉深度,每组随机(信封法)选取10例经桡动脉取血,测定基础值、气腹后20 min和气管拔管后20 min血中皮质醇、超敏C反应蛋白、血糖浓度和血气分析。结果气腹后20 min,观察组血中超敏C反应蛋白浓度中位数0.28 mg/L(0.01～2.15 mg/L),明显低于基础值中位数0.31 mg/L(0.01～2.63 mg/L)(Z=-2.521,P=0.012)。2组内各时点血中皮质醇浓度差异无统计学意义(P>0.05)。对照组血糖在气管拔管后20 min明显高于基础值(P=0.014)。2组间血中皮质醇浓度和血气分析差异无统计学意义(P>0.05)。结论小剂量右美托咪定术前输注复合舒芬太尼靶控输注和七氟烷全麻能在一定程度上抑制围术期应激反应。

Objective To investigate the effects on perioperative stress response of dexmedetomidine combined with sufentanil administered by target-controlled infusion （TCI） and sevoflurane in general anesthesia. Methods Forty patients with American Society of Anesthesiologists （ASA） physical status I or II , aged 18 -68 years old, scheduled for elective laparoseopie surgelT under general anesthesia from August 2017 to January 2018, were included in this study. The patients were randomly divided into two groups with 20 patients in each group by envolope method： study group and control group. Dexmedetomidine 0. 3 μg/kg was infused intravenously over 10 min just before induction of anesthesia in the study grollp, while the equal volume of normal saline was administered instead in the control group. Anesthesia was induced with sufentanil TCI combined with propofol TCI and intravenous injection of roeuronium. Anesthesia was maintained with sufentanil TCI combined with inhalation of sevoflurane and intermittent intravenous boluses of roeuronium as needed to maintain muscle relaxation. The depth of anesthesia was guided and controlled according to the target effect-site concentration of TCI and bispeetral index （BIS） monitoring in the two groups. Arterial blood samples were gathered in 10 patients randomly selected from each group for determination of blood eortisol, hypersensitive C-reactive protein （hs-CRP） , blood glucose concentrations and blood gas analysis at the time point of baseline, 20 min after pneumoperitoneum, and 20 rain after tracheal extubation. Results The median blood hs-CRP concentration was lower at the time point of 20 min after pneumoperitoneum [0.28 （0.01 - 2.15） mg/L] than the baseline values [0.31 （0.01 - 2.63） mg/L] （Z = - 2. 521, P = 0. 012） in the study group. There were no significant differences in values of blood eortisol concentration at each time point in the two groups （ P 〉 0.05 ）. The levels of blood glucose were higher at the time point of 20 min after tracheal extubation than the baseline values in the control group （P = 0. 014）. There were no significant differences in values of blood eortisol concentration and blood gas analysis between the two groups （P 〉 0.05）. Conclusion A small dose of dexmedetomidine, infused intravenously before induction of anesthesia, combined with sufentanil TCI and sevoflurane in general anesthesia can inhibit perioperative stress response to a certain extent.