右美托咪定对肺灌洗患者血流动力学及应激反应的影响

Effects of Dexmedetomidine on Hemodynamics and Stress Response in Patients with Lung Lavage

目的:观察右美托咪定对肺灌洗患者血流动力学及应激反应的影响。方法:选择大理大学第一附属医院择期行肺灌洗术的患者60例,随机分为对照组(C组)和右美托咪定组(D组)。D组于麻醉诱导前静脉输注右美托咪定;C组给予等体积的0.9%氯化钠溶液。记录两组患者右美托咪定或0.9%氯化钠溶液输注前(T0)、气管插管即刻(T1)、左肺灌洗开始时(T2)、右肺灌洗开始时(T3)、拔管时(T4)和拔管后5 min(T5)的平均动脉压(MAP)和心率(HR),同时检测各时间点血浆肾上腺素和去甲肾上腺素水平。结果:与T0比较,C组患者T1~T5时的MAP和HR均增高,D组患者仅在T4时刻MAP和HR增高明显;与C组比较,D组在T1,T2,T3和T4时的MAP和HR均明显降低,差异有统计学意义(P<0.05)。两组患者血浆肾上腺素和去甲肾上腺素在T1,T2,T3和T4时均有不同程度的增加,但与C组比较,D组患者各时间点的增加幅度明显减少,差异具有统计学意义(P<0.01)。结论:右美托咪定可抑制肺灌洗患者血流动力学波动和应激反应。

Objective:To observe the effects of dexmedetomidine on hemodynamics and stress response in patients with lung lavage.Methods:Sixty patients who underwent lung lavage in the First Affiliated Hospital of Dali University were randomly divided into two groups,i.e.,the control group(group C)and the dexmedetomidine group(group D).Group D was intravenously infused with dexmedetomidine before the induction of anesthesia;group C was given an equal volume of 0.9%sodium chloride solution.Before infusion of dexmedetomidine or 0.9%sodium chloride solution(T0),immediately after tracheal intubation(T1),at the beginning of left lung lavage(T2),at the beginning of right lung lavage(T3),and at extubation(T4),and 5 minutes after extubation(T5),the mean arterial pressure(MAP)and heart rate(HR)of the two groups of patients were recorded,and plasma epinephrine and norepinephrine levels were measured at each time point.Results:Compared with T0,MAP and HR were increased at T1 to T5 in group C.In group D,MAP and HR increased significantly only at T4.Compared with group C,MAP and HR in group D were significantly lower at T1,T2,T3 and T4,the differences were statistically significant(P<0.05).Plasma epinephrine and norepinephrine in the two groups increased at T1,T2,T3 and T4.However,compared with group C,the increase in the group D was significantly reduced in these time points,the differences were statistically significant(P<0.01).Conclusion:Dexmedetomidine can inhibit hemodynamic fluctuations and stress response in patients with lung lavage.