右美托咪定和利多卡因分别对腹腔镜胆囊切除术血流动力学和应激反应的影响

Effect of dexmedetomidine or lidocaine on hemodynamics and stress response in patients undergoing laparoscopic cholecystectomy

目的比较右美托咪定和利多卡因在腹腔镜胆囊切除术患者中减轻和调节由于气管插管和CO_(2)气腹引起的血流动力学不良反应以及神经内分泌应激反应方面的作用。方法选择2022年2月~2023年9月在浙江省温州市中西医结合医院接受腹腔镜胆囊切除术的患者138例。随机均分为3组(n=46)。右美托咪定组患者在诱导前15分钟静脉推注右美托咪定1μg/kg,随后以0.5μg/(kg·h)持续输注直至手术结束。利多卡因组患者在诱导前15分钟以1.5mg/kg的初始负荷剂量静脉推注利多卡因,然后以2.0mg/(kg·h)持续输注直至手术结束。对照组患者接受同实验组体积的生理盐水负荷剂量和输注剂量作为安慰剂对照。每个患者均接受了标准化的麻醉方案。分别于术前诱导前(基线值)、诱导时、之后术中每5分钟一次,直到麻醉结束拔管和进入PACU后10分钟测定心率(HR)和平均动脉压(MAP)血流动力学参数的变化。分别于诱导后即刻以及术后5分钟(神经肌肉阻滞逆转之前)采血检测血糖水平、血清皮质醇水平。结果与利多卡因组相比,右美托咪定组在诱导后10分钟至麻醉结束拔管后10分钟期间的心率和平均动脉压变化均降低,差异有统计学意义(P<0.05)。右美托咪定组血糖和血清皮质醇水平升高明显高于利多卡因组,差异有统计学意义(P<0.05)。结论输注右美托咪定与利多卡因相比,虽然右美托咪定对控制血流动力学反应有效,但利多卡因对降低应激反应激素有更好的效果,临床可权衡患者状态选择合适的麻醉药物。

Objective To compare the effects of dexmedetomidine and lidocaine in reducing and regulating hemodynamic adverse reactions and neuroendocrine stress responses caused by tracheal intubation and CO_(2)pneumoperitoneum in patients undergoing laparoscopic cholecystectomy.Method 138 patients who underwent laparoscopic cholecystectomy at Wenzhou Integrated Traditional Chinese and Western Medicine Hospital in Zhejiang Province from February 2022 to September 2023 were selected.Randomly divide into 3 groups(n=46).All patients fast for 6-8 hours.When arriving at the operating room,all patients received standard monitoring protocols,including electrocardiogram,pulse oxygen saturation,non-invasive blood pressure,and end expiratory carbon dioxide(ETCO_(2)).Patients in the dexmedetomidine group received intravenous infusion of 1μg/kg dexmedetomidine 15 minutes before induction,followed by continuous infusion of 0.5μg/(kg·h)until the end of surgery.Lidocaine group patients received intravenous infusion of lidocaine at an initial loading dose of 1.5mg/kg 15 minutes before induction,followed by continuous infusion at a dose of 2.0mg/(kg·h)until the end of surgery.The control group patients received the same volume of physiological saline loading dose and infusion dose as the placebo control.Each patient received a standardized anesthesia regimen.Changes in hemodynamic parameters such as heart rate(HR)and mean arterial pressure(MAP)were measured before preoperative induction(baseline value),during induction,and every 5 minutes during surgery until the end of anesthesia,extubation,and 10 minutes after entering PACU.Blood samples were collected immediately after induction and 5 minutes after surgery(before reversal of neuromuscular blockade)to measure blood glucose levels and serum cortisol levels.Results Compared with the lidocaine group,the dexmedetomidine group showed a decrease in heart rate and mean arterial pressure between 10 minutes after induction and 10 minutes after extubation at the end of anesthesia(P<0.05).In addition,the blood glucose and serum cortisol levels in the dexmedetomidine group were significantly higher than those in the lidocaine group(P<0.05).Conclusion Compared with lidocaine,infusion of dexmedetomidine has a better effect on controlling hemodynamic responses,but lidocaine has a better effect on reducing stress response hormones,which is also worth clinical consideration.