右美托咪定对椎管内麻醉手术患者应激反应的影响  

Effects of dexmedetomidine on stress response in patients under epidural anaesthesia

作　　者：胡明权 缪冬梅[1] 刘睿[1] 吴迪[1] 赵薇[1] 

机构地区：[1]四川省自贡市第四人民医院麻醉科,643000

出　　处：《临床麻醉学杂志》2015年第1期12-14,共3页Journal of Clinical Anesthesiology

摘　　要：目的观察右美托咪定对椎管内麻醉手术患者应激反应的影响。方法选择ASAⅠ或Ⅱ级需在硬膜外麻醉下行下肢手术的患者60例,男32例,女28例。随机均分为右美托咪定组（D组）、咪达唑仑组（M组）、丙泊酚组（P组）,麻醉完善后D组静脉给予浓度为4μg/ml的右美托咪定负荷量1μg/kg,维持剂量0.2μg·kg^-1·h^-1;M组给予咪达唑仑0.05mg/kg静脉注射1次;P组静脉输注丙泊酚负荷量1mg/kg,维持量2mg·kg^-1·h^-1;记录用药前（T0）、用药后10min（T1）、30min（T2）、60min（T3）、术毕（T4）时的MAP、HR、听觉诱发电位指数（AAI）值,并于T0、T4时抽取静脉血测定血浆皮质醇。结果T1～T4时三组AAI值均明显低于T0时（P〈0.01）;T3时P组AAI明显低于D、M组（P〈0.05）。T1～T4时三组MAP均明显低于T0时（P〈0.05或P〈0.01）;T2～T4时D、P组MAP均明显低于M组（P〈0.05）;T3、T4时D、P组HR明显慢于T0时和M组（P〈0.05）。T4时三组血浆皮质醇均明显低于T0时,且T4时D组血浆皮质醇明显低于P、M组（P〈0.05）。结论右美托咪定作为椎管内麻醉辅助用药,不仅具有良好的镇静、抗焦虑作用,对手术患者的应激反应有一定影响作用。Objective This study was to observe the effects of dexmedetomidine on stress response in patients under epidural anesthesia.Methods Sixty patients,male 32 and female 28,ASAⅠ orⅡ,undergoing lower extremity surgery under epidural anesthesia were randomly divided into the dexmedetomidine group（group D）,the midazolam group（group M）,and the propofol group（group P）.In group D,patients received intravenous 1μg/kg dexmedetomidine for 10 min after anesthesia,and 0.5μg·kg^-1·h^-1 dexmedetomidine infusion till the end of surgery.Patients in group M received 0.05mg/kg midazolam,while patients in group P received 1mg/kg propofol and a 2mg·kg^-1·h^-1 infusion.The MAP,HR,AAI were recorded before the administration of drugs（T0）,10 min（T1）,30min（T2）and 60min（T3）after the administration,and at the end of surgery（T4）.The expression of plasma cortisol was measured at T0 and T4.Results Compared with T0,AAI and MAP in the three groups at T1-T4 were significantly decreased（P〈0.05 or P〈0.01）.AAI in group P at T3 was lower than that in groups D and M（P〈0.05）,MAP in groups D and P at T2-T4 was lower than those in group M（P〈0.05）,HR in groups D and R at T3 and T4 was slower than those at T0 and group M（P〈0.05）.Compared with T0,the expression of cortisol was decreased at T4 in the three groups.Compared with group D,the expression of cortisol was increased in groups P and M at T4（P〈0.05）.Conclusion Dexmedetomidine,as an adjuvant for epidural anesthesia,may has an effect on reducing the stress response.

关 键 词：右美托咪定 椎管内麻醉 应激反应 

分 类 号：R614[医药卫生—麻醉学]