全麻复合右美托咪定或硬膜外阻滞对腹部手术应激反应的影响  

Comparison of stress reaction of general anesthesia combined with dexmedetomidine or epidural block

作　　者：何焱[1] 江鹤群[1] 王银模[1] 陈国忠[1] 

机构地区：[1]南京军区福州总医院麻醉科,350025

出　　处：《临床麻醉学杂志》2013年第12期1171-1173,共3页Journal of Clinical Anesthesiology

摘　　要：目的观察和比较全麻复合右美托咪定与全麻复合硬膜外阻滞对腹部手术患者应激反应的影响。方法择期腹部手术患者60例，年龄30~60岁，随机均分为三组，术中均采用静-吸复合麻醉，维持BIS45-50，其中D组麻醉诱导前给予右美托咪定负荷量4μg·kg-1·h-1，8min后再以0．8μg·kg-1·h-1维持至术毕。E组硬膜外阻滞平面固定在T4。C组术中给予等量生理盐水。分别于入室后即刻（T1）、气管插管后即刻（T2）、进腹探查时（T3）、关腹时（T4）采集静脉血测定血糖、血清皮质醇、肾上腺素、去甲肾上腺素浓度。结果与T1时比较，T2～T4时C组皮质醇、肾上腺素、去甲肾上腺素水平明显升高（P〈0．01）。与C组比较，R～T4时D组和E组皮质醇、肾上腺素、去甲肾上腺素浓度明显降低（P〈0．01）。结论全麻复合右美托咪定可降低患者应激反应，其程度与全麻复合硬膜外阻滞相当。Objective To compare the inhibition of stress reaction of general anesthesia combined with dexmedetomidine or epidural block. Methods Sixty ASA I or III patients aged 30-60 yrs scheduled for selective abdomen surgery were randomly divided into 3 groups （n= 20 each）： general anesthesia combined with dexmedetomidine group （group D）, general anesthesia associated with epidural block group （group E） and general anesthesia group （group C）. Dexmedetomidine was administered 4μg·kg-1·h-1 as priming done, and then 0. 8μg·kg-1·h-1 as maintaining dosage before anesthesia induction in group D. Epidural block was performed before anesthesia in group E with a T4 blocking level. Equal volume of saline solution with group D was administed in group C. Blood glucose, plasma cortisol, epinephrine, and norepinephrine were assayed at enter room （T1）, tracheal cannula （T2）, probe peritoneal cavity （T3）, close peritoneal cavity （T4） time points respectively. Results The plasma cortisol, epinephrine, norepinephrine, HR and MAP in group C were significantly increased at T2-T4 compared with those at T1 （P〈0. 01）. The plasma cortisol, epinephrine, norepinephrine in groups D and E were significantly decreased at T2-T4 compared with group C （P〈0.01）. Conclusion General anesthesia-dexmedetomidine could alleviate the extent of stress reaction while its effect was similar with general anesthesia-epidural blocking.

关 键 词：静一吸复合麻醉 硬膜外阻滞 右美托咪定 应激反应 

分 类 号：R614[医药卫生—麻醉学]