右美托咪定对麻醉诱导气管插管应激反应的影响.pdf

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1、622·北京医学2013年第35卷第8期·．论著．右美托咪定对麻醉诱导气管插管应激反应的影响冯雪辛冯鲲鹏1袁维秀。【摘要】目的评估麻醉诱导前单次输注右美托咪定对全身麻醉下气管插管应激反应的影响。方法采用随机、双盲的方法选择ASAIⅡ级6O例全麻下择期行妇科腹腔镜手术患者，年龄20～51岁，最终入选53例。分为右美托咪定组(DEX组．n：28)和安慰剂组(PLACEBO组，n=25)。诱导前15min两组患者分别接受静脉输注右美托咪定(0．6g，l(g)或等量生理盐水，随后靶控输注异丙酚(靶浓度为3Ixg／m1)、静脉注射芬

2、太尼(3Ixg／kg)和罗库溴铵(0．6mg／ks)进行麻醉诱导，待患者BIS<60时进行气管插管。观察气管插管前后血流动力学变化，采用高效液相色谱法检测麻醉诱导前和气管插管后即刻血浆中肾上腺素(E)与去甲肾上腺素(NE)含量。结果DEX组在麻醉诱导期间平均动脉血压及心率表现平稳．与气管插管前相比，PLACEBO组平均动脉血压和心率在气管插管后即刻显著升高(P<0．05)。插管后即刻DEX组血浆E和NE浓度明显低于PLACEBO组(P均<0．05)。结论麻醉诱导前单次输注右美托咪定可降低血浆中E和NE的浓度．从而减轻全身麻

3、醉下气管插管的应激反应，稳定血流动力学，对患者更加安全。【关键词】右美托咪定气管内插管应激反应血流动力学Theefectsofpre-anestheticsingle-dosedexmedetomidineonattenuationofstressresponsetoendotrachealintubationFENGXue-xin，FENGKun-peng,YUANWei-xiu(DepartmentofAnesthesiology，XuanwuHospital，CapitalMedicalUniversity，Beij

4、ing100053)【Abstract】ObjectiveToinvestigatetheefectsofpre—anestheticsingle—dosedexmedetomidineonattenuationofstressresponsetoendotrachealintubationinpatientswithgeneralanesthesia．MethodsSixtyASAI—IIpatientsaged20-51yeamscheduledforgynecologiclaparoscopyprocedurewit

5、hgeneralanesthesiawererandomlydividedintotwogroups．Finally53patientswereenrolled．Twenty—eightpatientswereinvolvedintogroupD(studygroup)，whoreceivedintravenousinfusionofdexmedetomidine0．6Ixg／kgdilutedwithnormalsalineforover15minbeforeinduction．Twenty-fivepatientswe

6、reinvolvedintogroupC(controlgroup)，whoreceivedthesanlevolumeofnormalsalineinfusion．Anesthesiawasinducedwithpropofol(target-controlledinfusion，withtheplasmaconcentrationof3Ixg／m1)，fentanyl(3p~g／kg)androcuronium(0．6mg／kg)．Endotrachealintubationwasperformedwhenplasma

7、concen~ationofpropofolreachedto3Ixg／m1．Hemodynamicparametersincludingheartrate(HR)andmeanarterialpressure(MAP)atthebaseline，beforeinduction(rightafterfinishinginfusionofdexmedetomidineornormalsaline)，andrightaftertrachealintubationweredocumented．Plasmaconcentratio

8、nsofnorepinephrineandepinephrineatbaselineandafterintubationweremeasuredbyhighperformanceliquidchromatography．ResultsInthegroupD，hemodynamicparameterswe