不同维持量右美托咪定对悬雍垂腭咽成形术全身麻醉恢复期血浆皮质醇和血糖的影响  

Effects of different maintain doses of Dexmedetomidine on plasma cortisol and glucose during anesthesia recovery period in patients undergoing uvulopalatopharyngoplasty under sevoflurane inhalation anesthesia

作　　者：王晓宁[1] 姜天乐[1] 赵斌江[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院麻醉科,北京100038

出　　处：《临床耳鼻咽喉头颈外科杂志》2014年第15期1154-1157,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的：观察不同维持量右美托咪定（DEX）对七氟醚吸入麻醉UPPP患者全身麻醉恢复期血浆皮质醇和血糖的影响。方法：择期全身麻醉行UPPP患者120例,ASA分级Ⅰ级或Ⅱ级。随机分为3组,每组40例：DEX低剂量维持量组（D1组）,DEX高剂量维持量组（D2组）和对照组（C组）。DEX组和C组分别接受初始剂量为1μg/kg的DEX和生理盐水,容量均为20ml,注药时间15min。随后D1组以0.2μg·kg-1·h-1,D2组以0.7μg·kg-1·h-1的速度维持至手术结束前5min,C组则给予相同维持速度的生理盐水。术中通过调节吸入七氟醚浓度,使BIS值维持40~60。手术结束前10min停用所有麻醉药,测定麻醉前（T0）,拔管时（T1）,拔管后5min（T2）、拔管后15min（T3）血浆皮质醇浓度和血糖;记录手术时间,吸入麻醉时间,术中七氟醚用量,停药后苏醒时间,气管导管拔除时间和围拔管期间发生躁动、呛咳及低氧血症（SpO2〈90%）的情况。结果：与C组比较,D1组和D2组在T1时MAP、HR明显降低（P〈0.05）,T1~T3时血浆皮质醇浓度及血糖明显降低（P〈0.05）,术中七氟醚用量明显减少（P〈0.05）,围拔管期躁动的发生率明显降低（P〈0.05）;D2组苏醒时间和气管导管拔除时间较C组和D1组明显延长（P〈0.05）;各组呛咳及低氧血症的发生率比较差异无统计学意义（P〉0.05）。结论：七氟醚吸入麻醉下UPPP中应用DEX 0.2μg·kg-1·h-1,麻醉恢复期血流动力学平稳且不抑制呼吸,减轻气管拔管时的应激反应,显著减少术中七氟醚用量和躁动的发生率,同时不延长术后苏醒和气管导管拔除时间。Objective：To observe the effects of different maintain doses of Dexmedetomidine on plasma cortisol and glucose during anesthesia recovery period in patients undergoing uvulopalatopharyngoplasty under sevoflurane inhalation anesthesia.Method：In this prospective,randomized,double-blind study,120ASA Ⅰ andⅡ patients undergoing selective uvulopalatopharyngoplasty under general anesthesia were included.The patients were randomly allocated to three groups（n= 40）：Dexmedetomidine low maintain dose group（D1）,Dexmedetomidine high maintain dose group（group D2）and control group（group C）.The Dexmedetomidine groups and control group were given Dexmedetomidine 1μg/kg and normal saline in 20ml within 15min just before induction of anesthesia.Then Dexmedetomidine were maintained at 0.2μg·kg-1·h-1 and 0.7μg·kg-1·h-1 in group D1and group D2and were withdrawed 5min before the end of operation,the same maintained speed of normal saline was given in group C.BIS value was maintained at 40-60by adjusting the inhaled concentration of sevoflurane.Anesthetic was withdrawed 10min before the end of operation.Thus,plasma cortisol concentration and blood glucose was needed to be detected just before anesthesia（T0）,tracheal extubation（T1）,5min after extubation（T2）and 15min after extubation（T3）.Duration of operation and anesthesia,consumption of sevoflurane,emergence time,extubation time,the occurrence of dysphoria,bucking and hypoxemia（SpO2＆lt;90%）during extubation were recorded.Result：Compared with group C,MAP and HR at T1,plasma cortisol concentration and blood glucose at T1-T3were all significantly lower in group D1and group D2（P＆lt;0.05）,and so were the consumption of sevoflurane and the occurrence of dysphoria（P＆lt;0.05）.The emergence time and extubation time were significantly prolonged in group D2compared with group D1and group C（P＆lt;0.05）.There was no significant difference in the occurrence of bucking and hypoxemia in three groups（P＆gt;0.05）.Conclusion：I

关 键 词：右美托咪定 悬雍垂腭咽成形术 麻醉恢复期 应激 

分 类 号：R767.91[医药卫生—耳鼻咽喉科]