右美托咪定复合依托咪酯在高血压患者麻醉诱导插管中的应用价值和对PI3K、Akt蛋白表达的影响

Application Value of Dexmedetomidine Combined with Etomidine in Anesthesia-induced Intubation in Hypertensive Patients and Its Effect on PI3K、Akt Protein Expression

目的:分析右美托咪定复合依托咪酯在高血压患者麻醉诱导插管中的应用效果。方法:选取2018年5月至2020年5月赣州市肿瘤医院高血压全身麻醉手术患者70例,按随机数字表法分为观察组(n=35)与对照组(n=35),对照组采用生理盐水复合依托咪酯,观察组采用右美托咪定复合依托咪酯。对比两组麻醉诱导前(T0)、麻醉诱导后4 min(T1)、气管插管即刻(T2)、气管插管后3 min(T3)血流动力学[收缩压(SBP)、舒张压(DBP)、心率(HR)]变化,并对比两组术前、术后24 h、术后48 h的3羧基磷脂酰肌醇激酶(PI3K)和蛋白激酶B(Akt)变化。结果:T1、T2、T3观察组SBP、DBP、HR水平较对照组低(P<0.05);观察组拔管、睁眼、自主呼吸恢复时间较对照组短(P<0.05);术后24 h、术后48 h,观察组PI3K、Akt蛋白水平较对照组高(P<0.05)。结论:右美托咪定复合依托咪酯应用于高血压全身麻醉手术患者麻醉诱导插管中,可减轻应激反应,维持血流动力学稳定,可降低对PI3K-Akt通路的影响,加快术后恢复。

Objective:To analyze the application value of dexmedetomidine combined with etomidate in anesthesia induction and intubation in patients with hypertension.Methods:70 patients with hypertension undergoing general anesthesia in Ganzhou Cancer Hospital from May 2018 to may 2020 were randomly divided into observation group(n=35)and control group(n=35).The control group was treated with normal saline combined with etomidate,and the observation group was treated with dexmedetomidine combined with etomidate.The changes of hemodynamics(SBP,DBP,HR)before anesthesia induction(T0),4 min after anesthesia induction(T1),immediately after tracheal intubation(T2),and 3 min after tracheal intubation(T3)were compared between the two groups.The postoperative situation and the changes of 3-carboxyl phosphatidylinositol kinase(PI3K)and protein kinase B(Akt)were compared between the two groups before anesthesia induction(T0),4 min after anesthesia induction(T1),immediately after tracheal intubation(T2),and 3 min after tracheal intubation(T3).Results:The levels of SBP,DBP and HR in T1,T2 and T3 observation group were lower than those in control group(P<0.05);the recovery time of extubation,eye opening and spontaneous breathing in observation group was shorter than that in control group(P<0.05);the protein levels of PI3K and Akt in observation group were higher than those in control group at 24 h and 48 h after operation(P<0.05).Conclusion:Dexmedetomidine combined with etomidate can reduce stress reaction,maintain hemodynamic stability,reduce the influence on PI3K-Akt pathway and accelerate postoperative recovery.