摘要
目的探讨行开颅术患者麻醉诱导后静脉泵注右美托咪定对开颅期间应激反应及血流动力学的影响。方法行开颅术患者90例,随机分为右美托咪定组、局部麻醉组、对照组各30例。右美托咪定组麻醉诱导后静脉泵注右美托咪定20mL,20min内泵注完毕;局部麻醉组麻醉诱导后立即给予0.5%罗哌卡因20mL切口浸润麻醉;对照组麻醉诱导后立即静脉泵注生理盐水20mL,20min内泵注完毕。记录3组入室后(T_0)、气管插管前(T_1)、气管插管后1min(T_2)、切皮前(T_3)、切皮后1min(T_4)、切皮后2min(T_5)、打开颅骨前(T_6)、打开颅骨后1min(T_7)收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)及心率变化,检测T_0、T_7时静脉血血糖、去甲肾上腺素和肾上腺素水平。结果右美托咪定组T_2时SBP、DBP、心率均低于局部麻醉组和对照组(P<0.05),局部麻醉组和对照组比较差异无统计学意义(P>0.05);右美托咪定组、局部麻醉组T_4、T_5时SBP、DBP、心率均低于对照组(P<0.05),右美托咪定组与局部麻醉组比较差异无统计学意义(P>0.05);T_6、T_7时SBP、DBP在右美托咪定组、局部麻醉组、对照组依次升高(P<0.05);右美托咪定组T_7时心率均低于局部麻醉组和对照组(P<0.05),局部麻醉组与对照组比较差异无统计学意义(P>0.05);右美托咪定组T_7时血糖[(4.2±0.3)mmol/L]、去甲肾上腺素[(330±20)pmol/L]、肾上腺素[(125±12)pmol/L]水平与T_0[(4.0±0.3)、(320±15)、(110±10)pmol/L]比较差异无统计学意义(P>0.05);局部麻醉组、对照组T_7时血糖[(5.2±0.4)、(6.2±0.5)pmol/L]、去甲肾上腺素[(380±25)、(420±22)mmol/L]、肾上腺素[(140±11)、(170±15)pmol/L]水平均高于T_0(P<0.05);右美托咪定组T_7时血糖、去甲肾上腺素、肾上腺素水平低于局部麻醉组和对照组(P<0.05),局部麻醉组与对照组比较差异无统计学意义(P>0.05)。结论术前应用右美托咪定可明显降低开颅手术患者的应激反应,维持血流动力学稳定。
Objective To investigate the effect of dexmedetomidine during anesthetic induction on stress response and hemodynamics in patients undergoing craniotomy.Methods Ninety patients undergoing craniotomy were randomly divided into dexmedetomidine group,local anesthesia group and control group,with 30 patients in each group.After anesthetic induction,dexmedetomidine group was intravenously injected 20 mL dexmedetomidine within 20 min,local anesthesia group was given local infiltration anesthesia with 0.5% ropivacaine 20mL in incision,and control group was intravenously injected 20 mL normal saline within 20 minutes.The systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate were recorded at the time points of entering operation room(T0),before tracheal intubation(T1),1min after tracheal intubation(T2),before skin incision(T3),1min after skin incision(T4),2min after skin incision(T5),before craniotomy(T6)and 1min after craniotomy(T7).The levels of glucose,norepinephrine and adrenaline were detected at T0and T7.Results SBP,DBP and heart rate were significantly lower in dexmedetomidine group than those in local anesthesia group and control group(P<0.05),and showed no significant differences between local anesthesia group and control group at T2(P>0.05).SBP,DBP and heart rate were significantly lower in dexmedetomidine group and local anesthesia group than those in control group at T4and T5(P<0.05),and showed no significant difference between dexmedetomidine group and local anesthesia group(P>0.05).SBP and DBP were gradually elevated in dexmedetomidine group,local anesthesia group and control group in turns at T6and T7(P<0.05),while heart rate was significantly lower in dexmedetomidine group than that in local anesthesia group and control group at T7(P<0.05),showed no significant difference between local anesthesiagroup and control group(P>0.05).In dexmedetomidine group,there were no significant differences in the levels of blood glucose((4.2±0.3)mmol/L),norepinephrine((330±20)pmol/L)and adrenaline((125±12)pmol/L)at T7compared with those at T0((4.0±0.3)mmol/L,(320±15)pmol/L,(110±10)pmol/L)(P>0.05).The levels of blood glucose((5.2±0.4),(6.2±0.5)pmol/L),norepinephrine((380±25),(420±22)mmol/L)and adrenaline((140±11),(170±15)pmol/L)at T7 were significantly higher than those at T0in local anesthesia group and control group(P<0.05).The levels of blood glucose,norepinephrine and epinephrine were significantly lower in dexmedetomidine group than those in local anesthesia group and control group at T7(P<0.05),and showed no significant differences between local anesthesia group and control group(P>0.05).Conclusion Preoperative application of dexmedetomidine can significantly reduce stress response and maintain hemodynamic stability in patients undergoing craniotomy.
作者
李璐
孟凡民
姚翔燕
LI Lu;MENG Fanmin;YAO Xiangyan(Department of Anesthesiology,Henan Provincial People's Hospital, People's Hospital of Zhengzhou University,Zhengzhou 450003,China)
出处
《中华实用诊断与治疗杂志》
2019年第1期83-85,共3页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省卫生厅科技攻关项目(122102310622)
作者简介
通信作者:姚翔燕,E-mail:78417374@qq.com。
