右美托咪定对深度麻醉患者HMGB1水平及血流动力学指标的影响

Effect of dexmedetomidine on HMGB1 level and hemodynamics in patients with deep anesthesia

目的探讨右美托咪定对深度麻醉患者高迁移率族蛋白B1水平及血流动力学指标的影响.方法将82例行腹部手术的患者采用随机数字表法分为观察组与对照组,各41例.观察组在麻醉诱导前给予右美托咪定,对照组给予等量的0.9%氯化钠注射液.比较两组患者右美托咪定输入前、右美托咪定输入10min时、右美托咪定输入20min时、手术结束时高迁移率族蛋白B1、平均动脉压、心率水平,采用疼痛数字评分法及Ramsay镇静评分评定两组患者的疼痛情况及镇痛效果,比较两组麻醉药物用量,比较两组苏醒时间、拔管时间及呼吸恢复时间.结果右美托咪定输入10min时、右美托咪定输入20min时、手术结束时两组血清高迁移率族蛋白B1水平均显著高于右美托咪定输入前(P<0.01).观察组各时间点平均动脉压及心率水平变化差异无统计学意义(P>0.05);观察组右美托咪定输入10min时、右美托咪定输入20min时平均动脉压水平显著低于对照组(P<0.05或0.01),右美托咪定输入10min时、右美托咪定输入20min时、手术结束时心率水平显著低于对照组(P<0.05或0.01);对照组右美托咪定输入10min时、右美托咪定输入20min时、手术结束时平均动脉压及心率水平均显著高于右美托咪定输入前(P<0.05或0.01).术后1h、3h观察组疼痛数字评分法及Ramsay镇静评分均显著低于对照组(P<0.01),全麻药物用量显著少于对照组(P<0.01).观察组苏醒时间、拔管时间及呼吸恢复时间均显著短于对照组(P<0.01).结论右美托咪定可使深度麻醉患者的高迁移率族蛋白B1及血流动力学水平维持稳定状态,镇静镇痛效果突出,同时可以减少麻醉药物用量,缩短苏醒时间、拔管时间和呼吸恢复时间,安全性高,值得临床进一步推广.

Objective To investigate the effect of dexmedetomidine on HMGB1 level and hemodynamics in patients with deep anesthesia.Methods 82 patients undergoing abdominal surgery were randomly divided into observation group and control group,41 cases in each group.Dex medetomidine was injected in the observation group before induction of anesthesia,and 0.9% sodium chloride injection in the control group. HM GB1,mean arterial pressure,and heart rate were compared between the two groups of patients before dex medetomidine input,dex medeto midine input for 10 min,dex medetomidine input for 20 min,and end of surgery.Pain and analgesic effects were assessed in both groups using DRS and Ramsay sedation score. The doses of anesthetic drugs were compared between the two groups,and the recovery time,ex tubation time and respiratory recovery time of the two groups were compared.Results Serum HMGB1 levels at dex medetomidine input for 10 min,20 min and at the end of surgery were significantly higher than those before dex medeto midine ( P< 0.01 ).There was no significant difference in mean arterial pressure and heart rate in the observation group at each time point ( P> 0.05 ).The m ean arterial pressure level of the dex m edeto midine in the observation group were sig nificantly lower than those of the control group at dexmedetomidine input for 10 min and 20 min ( P<0.05 or 0.01).The heart rate were significantly lower than those of the control group at dex medetomidine input for 10 min,20 min,and at the end of surgery ( P<0.05 or 0.01).The mean arterial pressure and heart rate of in the control group at dexmedetomidine input for 10 min and 20 min were significantly higher than those before dex medetomidine input ( P<0.05 or 0.01).The N RS and Ramsay sedation score of the observation group were significantly lower than those of the control group at 1 h and 3 h after operation ( P<0.01 ),and the total anesthetic dose was significantly lower than that of the control group ( P<0.01).The recovery time,ex tubation time and respiratory recovery time of the observation group were significantly shorter than those of the control group ( P<0.01).Conclusion Dex medeto midine can maintain HM GB1 and hemodynamics levels in patients with deep anesthesia,and the effect of sedation and an-algesia is outstanding.At the same time,it can reduce the amount of anesthetic drugs,shorten the recov-ery time,ex tubation time and respiratory recovery time,and has high safety,which is worth further clinical promotion.