右美托咪定对硬膜外麻醉结直肠手术患者围术期应激反应的影响

Influence of Dexmedetomidine on the Perioperative Stress Response of the Patients Undergoing Colorectal Surgery Under Epidural Anesthesia

为探讨右美托咪定对硬膜外麻醉结直肠手术患者围术期应激反应的影响,将120例拟于硬膜外麻醉下行结直肠手术的患者随机分为A、B、C 3组,各40例,硬膜外麻醉后、切开皮肤前,A组静脉输注4μg/mL右美托咪定[负荷量1μg/kg,10min输完,然后维持0.2μg/(kg·h)持续泵注],B组静脉输注丙泊酚[负荷量1mg/kg,1min输完,然后维持2mg/(kg·h)持续泵注],C组静脉注射咪达唑仑(0.05mg/kg)。比较3组患者用药前(T0)、用药后10min(T_(1))、30min(T_(2))、60min(T_(3))和手术结束时(T_(4))的心率(HR)、平均动脉压(MAP)、听觉诱发电位指数(AAI),以及T0和T_(4)血浆皮质醇含量。结果显示,A组和B组患者T_(1)、T_(2)、T_(3)与T_(4)的HR均低于C组,P<0.05;A组、B组各时点HR比较差异无统计学意义,P>0.05。A组和B组患者T_(2)、T_(3)、T_(4)的MAP均低于C组,P<0.05;A组、B组T_(2)、T_(3)、T_(4)的MAP比较差异无统计学意义,P>0.05。3组患者T_(1)~T_(4)的AAI值均低于T0,P<0.05;除B组患者T_(3)的AAI值低于A组、C组,P<0.05,其他时刻各组间AAI值比较差异无统计学意义,P>0.05。3组患者T_(4)血浆皮质醇含量均较T0明显降低,其中A组最低,明显低于B组和C组,P<0.05。结果表明,右美托咪定用于硬膜外麻醉结直肠手术可取得良好的镇静效果,而且可降低机体应激反应。

This study was to investigate the influence of Dexmedetomidine(DEX)on the perioperative stress response of the patients undergoing colorectal surgery under epidural anesthesia,randomly divided 120 patients to be subject to colorectal surgery under epidural anesthesia into group A,B,and C,40 cases for each;after the 120 patients were performed on epidural anesthesia,and before the skin was cut,group A was injected intravenously 4μg/mL DEX[loaded volume:1μg/kg,injected completed within 10 min,then,keeping 0.2μg/(kg·h),continously pumping];group B,propofol[loated volume,1μg/kg,within 1 min,keeping 2 mg/(kg·h),continously pumping];group C,midazolam,0.05 mg/kg;then,compared three groups’patients’at T0(before usage of drugs),T_(1)(10 min,after usage of drugs),T_(2)(30 min),T_(3)(60 min),and T_(4)(at the end of surgery)points’HR,MAP,AAI,as well as the contents of plasma cortisol at T0 and T_(4) points.As results,the HR at T_(1)-T_(4) in group A and group B were all lower than that at the same interals in group C(P<0.05),but between group A and group B there was no statistical difference(P>0.05);the MAP at T_(2)-T_(4) in group A and B were lower than that at the same interals in group C(P<0.05),but between group A and group B there was no statistical difference(P>0.05);the AAI values at T_(1)-T_(4) in three groups were all lower than the value at T0 in three groups(P<0.05),more than the AAI value of group B at T_(3) was lower than that in group A,and group C at T_(3)(P<0.05),at rest time-points there was no statistical difference between the three groups(P>0.05);the plasma cortisol contents at T_(4) in three groups was significantly declined than that at T0,espectially,most lower in group A which was significantly lower than in group B and C(P<0.05).Results show that DEX used in colorectal surgery under epidural anesthesia can achieve good sedative efficacy,and reduce body stress response.