预注右美托咪定对甲状腺手术全麻苏醒期肾素-血管紧张素-醛固酮系统的影响  

Effects of pre-injection of dexmedetomidine on renin-angiotensin-aldosterone system during recovery period of general anesthesia in thyroid surgery

作　　者：何绮霞[1] 卢燕[1] 顾晓霞[1] 张良清[1] 

机构地区：[1]广东医学院附属医院麻醉科,湛江市524001

出　　处：《实用医学杂志》2015年第1期125-127,共3页The Journal of Practical Medicine

基　　金：广东省科技计划项目(编号:2011B031800230)

摘　　要：目的：观察预注右美托咪定对甲状腺手术全麻苏醒期肾素-血管紧张素-醛固酮系统（RAAS）的影响。方法：40例ASAⅠ或Ⅱ级择期行甲状腺瘤切除手术患者随机均分为右美托咪定组（D组）和对照组（C组）。D组麻醉前30min静脉泵注右美托咪定（DEX）1μg／kg，15min注射完；C组泵注生理盐水。两组均静注咪达唑仑、依托咪酯、舒芬太尼、顺式阿曲库铵进行麻醉诱导。持续泵注丙泊酚和顺式阿曲库铵进行麻醉维持，记录两组麻醉前（T1）、手术结束（T2）、气管导管拔管（T3）及气管导管拔管后30min（T4）MAP、HR。并留T1～T4时静脉血，检测肾素活性（PRA）、血管紧张素-Ⅱ（ANG—Ⅱ）和醛固酮（ALD）含量。结果：与C组比较，T2、T3、T4时D组MAP明显降低，HR明显减慢（P〈0．05），PRA、ANG—II和ALD降低（P〈0．05）。结论：预注右美托咪定能减轻甲状腺手术全麻苏醒期应激反应，抑制RAAS过度分泌，有利于循环系统的稳定。Objective To observe the effects of pre-injection of dexmedetomidine （DEX） on renin- angiotensin-aldosterone system （RAAS） during recovery period of general anesthesia in thyroid surgery. Methods Forty patients with ASA Ⅰ or Ⅱ undergoing elective resection of thyroid tumors were randomized into DEX group and control group with 20 cases in each. Two groups respectively received DEX and normal saline by target controlled perfusion （intravenous DEX 1 μg/kg） or tales doses of saline for 30 min before anesthesia.Then general anesthesia was inducted by intravenous injection of midazolam,sufentanil,etomidate and cisatracurium And the maintainence of anesthesia was kept by cisatracurium and propofol intravenous in both groups. MAP, HR and the plasma concentration of PRA, ANG-Ⅱ , ALD were recorded before anesthesia（T1）, immediate end of surgery （T2）, extubation （T3）, 30 minute after extubation （T4）. Results More stable hemodynamics was found in DEX group during recovery period of general anesthesia in thyroid surgery. Blood pressure, heart rate in DEX group decreased significantly immediate end of surgery, extubation and 30 min after extubation （P 〈 0.05） when compared with those in control group ; the plasma concentration of PRA, ANG- Ⅱ , ALD also decreased significantly immediate end of surgery, extubation and 30 minute after extubation （P 〈 0.05）. Conclusions Target controlled perfusion of DEX with 1 μg/kg 30 minutes before anesthesia decreases blood pressure, heart rate with more stable hemodynamics during recovery period of general anesthesia in thyroid surgery. It also inhibits the RAAS secretion and stress response.

关 键 词：右美托咪定 RAAS 全麻苏醒期 应激反应 

分 类 号：R614[医药卫生—麻醉学]