右美托咪定对大面积烧伤患者静脉全身麻醉切痂植皮术应激反应的影响  

Effects of Dexmedetomidine on stress response to intravenous anesthesia on large area excision of eschar and skin grafting operation in burned patients

作　　者：王大龙[1] 张海山[1] 郑观荣[1] 徐伟民[1] 葛维鹏[1] 

机构地区：[1]山东省胜利油田中心医院麻醉科,山东东营257034

出　　处：《中国现代医学杂志》2014年第20期73-76,共4页China Journal of Modern Medicine

摘　　要：目的探讨右美托咪定对大面积烧伤患者静脉全身麻醉（全麻）切痂植皮术应激反应的影响。方法选择择期行大面积烧伤削痂植皮术患者60例,ASAⅠ、Ⅱ级,随机均分成生理盐水对照组（S组）和右美托咪定组（D组）。诱导前10 min D组静脉泵注负荷量的右美托咪定（1μg/kg,10 min）。泵完以0.5μg/（kg·h）的右美托咪定维持,S组泵注相同剂量的生理盐水。两组均以氯胺酮1.0mg/kg,丙泊酚1.0mg/kg静注诱导,氯胺酮2.0-4.0mg/（kg·h）泵注复合丙泊酚2-4μg/mL靶控输注维持麻醉深度,使患者BIS值维持在46-55。观察两组诱导前（T0）、诱导后（T1）,削痂（T2）、取皮（T3）、植皮（T4）、手术结束（T5）各时间点MAP、HR变化及测定血浆肾上腺素（Epinephrine,E）、去甲肾上腺素（Norepinephrine,NE）、皮质醇（Cortisol,COR）、血糖（Glucose,GLU）含量。记录从停药到意识恢复时间、出现呼吸抑制患者例数及苏醒期发生恶心呕吐、躁动患者例数。结果与T0时相比较,S组在T2-T5时HR明显增快,MAP明显增高（P〈0.05）,且均高于D组（P〈0.05）,而D组在T0-T5HR、MAP无明显变化（P〉0.05）。在T2-T5时,S组的E、NE、COR、GLU明显高于T0时和D组（P〈0.05）。两组的意识恢复时间,出现呼吸抑制患者例数无明显差异。但是,S组术后恶心呕吐、躁动的发生率明显高于D组（P〈0.05）。结论右美托咪定可降低大面积烧伤患者静脉全麻切痂植皮术的应激反应,并且可以较少相关并发症。[Objective] To investigate effects of Dexmedetomidine on stress response to intravenous anes- thesia on large area excision of eschar and skin grafting operation in burned patients. [Methods ] Sixty cases of large area burned patients （ASA I , II ） undergone excision of eschar operation were randomly divided into two groups： physiological saline group （group S） and Dexmedetomidine group （Group D）. Group D was given a loading dose of Dexmedetomidine 1.0μg/kg, 10 min, and then maintained with 0.5 μg/（kg·h）. Group S was given the same dose of physiological saline. After the loading dose pumped, Ketamine 1.0 - 2.0 mg/kg and Propofol 1.0 mg/kg were given for intravenous induction, then ketamine 3.0- 4.0 mg/（kg·h） and Propofol 2.0 4.0μg/mL was pumped infusion for maintenance the depth of anesthesia （BIS： 46 - 55）. MAP and HR of two gropes were recorded before （To） and after （T1） induction, tangential excision （T2）, taking the skin （T3）, skin grafting （T4） and the end of surgery （Ts）. At the same time in the above the corresponding points, venous blood sample was taken to measure the plasma concentrations of epinephrine （E）, norepinephrine （NE）, cortisol （COR） and blood Glucose （GLU）. The consciousness recovery time, the cases of intraoperative respiratory inhi- bition, postoperative nausea and vomiting and restless were recorded as well. [Results] Compared with T-, HR increased significantly faster （P 〈0.05）, MAP increased significantly （P 〈0.05） at T2 - T5 in group S. In group D, the change of HR and MAP was not obvious. Compared with group D, HR, MAP in group S were increased obviously at the time of T2 - T5 （P 〈0.05）. Compared with group D, the lever of E, NE, COR and GLU were increased significantly （P 〈0.05 ） at T2 - T5 in group S. The consciousness recovery time and the cases of intraoperative respiratory inhibition in two groups was not significantly different, but the incidence rate of postoperative nausea and vomit

关 键 词：右美托咪定 静脉全身麻醉 大面积烧伤 切痂植皮术 应激 

分 类 号：R614.2[医药卫生—麻醉学]