右美托咪定对胃肠道开腹手术全麻患者肾素-血管紧张素-醛固酮系统的影响  

Effects of dexmedetomidine hydrochlorid in renin-angiotensin-aldosterone system on patients with abdominal operation

作　　者：卢燕[1] 何绮霞[1] 蔡树云[1] 杨志[2] 姚业兴[1] 

机构地区：[1]广东医学院附属医院麻醉科,广东湛江524001 [2]广东省韶关市粤北人民医院神经内科,广东韶关512000

出　　处：《中国当代医药》2012年第28期10-12,共3页China Modern Medicine

摘　　要：目的探讨右美托咪定(Dex)对胃肠道开腹手术全麻患者肾素-血管紧张素-醛固酮系统(RAAS)的影响。方法将40例择期在全麻下行胃肠道开腹手术治疗的患者随机分为右美托咪定组(D组)和0.9%氯化钠溶液组(C组),每组20例,全麻诱导前两组患者静脉分别微泵输注Dex0.4μg/kg(D组)和等容量0.9%氯化钠溶液(C组),持续输注时间为15min;随后微泵输注异丙酚、静脉注射咪唑安定、舒芬太尼、顺式阿曲库铵进行麻醉诱导,以七氟醚及异丙酚维持麻醉深度。观察SBP、DBP、HR,检测患者麻醉前(T0)、气管插管时(T1)、切皮后1min(T2)、术毕(T3)、拔气管导管(T4)等时点血浆肾素活性(PRA)、血管紧张素-Ⅱ(ANG-Ⅱ)和醛固酮(ALD)的含量。结果 D组在全身麻醉期间血流动力学表现平稳,D组平均动脉血压在气管插管时(T1)、切皮后1min(T2)、拔气管导管(T4)时点较C组降低(P<0.05)。D组患者血浆肾素活性(PRA)、血管紧张素-Ⅱ(ANG-Ⅱ)和醛固酮(ALD)在T1、T2、T4时点也较C组显著降低(P<0.05)。结论胃肠道开腹手术全麻患者输注右美托咪定可稳定血流动力学,抑制RAAS分泌。Objective To investigate the effects of dexmedetomidine hydrochlorid （Dex） in renin-angiotensin-aldosterone system （RAAS） on patients with abdominal operation. Methods Forty patients were admitted for abdominal operation in general anesthesia were randomly assigned into the group C （normal saline） and group D （dexmedetomidine）. Each group had twenty cases. Two groups respectively received dexmedetomidine hydrochloride and normal saline by target controlled perfusion （intravenous dexmedetomidine 0.4 μg/kg or tales doses of saline） for 15 minutes before induction. Then general anes thesia was inducted by target controlled perfusion of propofol, intravenous injection of midazolam, sufentanil and cisatracuriurn. The maintainenee of anesthesia used by sevoflurane inhalation and propofol intravenous in both groups. Patients＂ blood pressure, heart rate and the plasma concentration of PRA, ANG- Ⅱ, ALD were recorded at the time of entering the operat ing room, induction, 1 minute after skin incision, after operation and extubation. Results Hemodynamies in Dex presented more stable during the whole period of general anesthesia. Compared with group C, blood pressure, heart rate in Dex group decreased significantly induction, 1 minute after skin incision and extubation（P 〈 0.05）. The plasma concentration of PRA, ANG- ]l, ALD were also decreased significantly induction, 1 minute after skin incision and extubation （P 〈 0.05）. Conclusion Target controlled perfusion of dexmedetomidine bydroehloride with 0.4 μg/kg for 15 minutes before induction decreases blood pressure, heart rate with more stable hemodynamies in abdominal operation, it also inhibit the RAAS secretion.

关 键 词：右美托咪定 血流动力学 肾素-血管紧张素-醛固酮系统 麻醉 

分 类 号：R614.2[医药卫生—麻醉学]