右美托咪定对腹腔镜下阑尾切除术患者肝肾功能及应激反应的影响  

Influence of Dexmedetomidine on stress reaction and hepatic/renal function in the process of laparoscopic abdominal surgery

作　　者：孟海兵[1] 来玮[1] 王信磊[1] 丁国友[1] 张晓光[2] 

机构地区：[1]解放军第九四医院麻醉科,江西南昌330002 [2]复旦大学附属中山医院麻醉科,上海200032

出　　处：《中国医药导报》2013年第31期97-99,103,共4页China Medical Herald

基　　金：国家自然科学基金资助项目(编号81100796)

摘　　要：目的研究分析右美托咪定对腹腔镜下阑尾切除术患者肝肾功能及应激反应的影响。方法以解放军第九四医院收治的128例行腹腔镜阑尾切除术的患者为研究对象,随机分成联合组和单用组,各64例。联合组采用右美托咪定加丙泊酚进行麻醉诱导和维持,而单用组采用丙泊酚进行麻醉诱导和维持。对麻醉前、插管后1 min、术后5 min的血清皮质醇和儿茶酚胺水平进行测定,同时测定术前及术后的肝肾功能。结果单用组丙泊酚诱导剂量以及维持剂量均明显高于联合组,差异有统计学意义(P<0.05);两组患者插管后1 min血清皮质醇、肾上腺素、去甲肾上腺素水平均较麻醉前明显降低(P<0.05),术后5 min单用组患者肾上腺素、去甲肾上腺素水平较麻醉前均明显升高(P<0.05);两组患者术后5 min血清多巴胺水平均较麻醉前明显上升(P<0.05);两组患者术后尿素氮水平较麻醉前明显降低,血糖较麻醉前明显升高(P<0.05)。结论右美托咪定联合小剂量丙泊酚可以有效减少气管插管时的应激反应,并使丙泊酚的使用剂量减少,对肝肾功能无明显影响,值得在临床实践中加以推广应用。Objective To investigate the influence of Dexmedetomidine on stress reaction and hepatic/renal function in the process of laparoscopic appendectomy. Methods 128 patients scheduled for laparoscopic appendectomy admitted to the 94th Hospital of People＇s Liberation Army were randomly divided into the combined group and the single-drug group, each with 64 patients. The combined group was given Dexmedetomidine and Propofol, while the single-drug group was given Propofol for induction and maintenance of anesthetics. Venous blood samples were collected before anesthetics, 1 min after intubation and 5 min after surgery for the determination of plasma concentrations of cortisol, dopamine, epinephrine and norepinephrine. Hepatic/renal function was assessed before and after surgery. Results The dose of induction and maintenance in the single- drug group was significantly higher than that in the combined group （P 〈 0.05）. In two groups, cortisol plasma concentration, serum epinephrine and norepinephrine levels 1 min after intubation lowered significantly compared with that before intubation （P 〈 0.05）. Serum epinephrine and norepinephrine levels 5 min after surgery in single-drug group rose significantly compared with that before intubation （P 〈 0.05）. In two groups, serum dopamine level rose significantly compared with that before intu- bation （P 〈 0.05）. Urea nitrogen level 5 min after surgery in＇ two groups lowered significantly compared with that before intu- bation, while blood glucose level rose significantly （P 〈 0.05）. Conclusion Dexmedetomidine combined with small dose of Propofol can reduce the stress response during tracheal intubation effectively and the dose of Propofol. It has no significant ef- fect on liver and kidney function.

关 键 词：右美托咪定 腹腔镜 肝肾功能 应激 

分 类 号：R614.2[医药卫生—麻醉学]