利多卡因复合右美托咪定星状神经节阻滞对CO_2气腹患者应激反应的影响  

Effects of stellate ganglion block with lidocaine combined dexmedetomidine on stress response in patients with CO_2 pneumoperitoneum

作　　者：翁嫣初[1] 刘思兰[2] 陈贤萍[1] 苏惠斌[1] 潘建华[1] 许中[3] 周莉莉[3] 

机构地区：[1]苏州市立医院东区麻醉科,江苏省215001 [2]苏州大学附属第一医院麻醉科 [3]苏州市立医院检验科,江苏省215001

出　　处：《江苏医药》2016年第3期295-297,共3页Jiangsu Medical Journal

摘　　要：目的观察星状神经节阻滞(SGB)对CO2气腹患者应激反应的影响。方法腹腔镜下胆囊切除术患者71例随机分为四组,于全身麻醉气管插管后即刻实施超声引导下右侧SGB。阻滞用药分别为生理盐水(C组,15例)、1%利多卡因(L组,19例)、右美托咪定0.5μg/kg(D组,18例)和1%利多卡因复合右美托咪定0.5μg/kg(LD组,19例),容量均为8ml。记录麻醉前、SGB后5min、建立人工气腹后10min和手术结束时的MAP、HR的变化,采用罗氏电化学发光仪检测皮质醇(Cor),酶标仪检测肾上腺素(E)、去甲肾上腺素(NE)和多巴胺(D)浓度。结果 SGB后5min,四组MAP均较麻醉前下降(P<0.05),L组和LD组的HR也较麻醉前减慢(P<0.05)。建立人工气腹后10min,C组和D组的MAP和HR均较SGB后5min上升(P<0.05);L组和LD组的MAP和HR也较SGB后5min上升(P<0.05),但低于C组和D组(P<0.05)。建立人工气腹10min,四组血浆Cor、E、NE和D浓度均较麻醉前上升(P<0.05);L组和LD组的各项指标低于C组和D组(P<0.05)。结论右侧利多卡因或利多卡因复合右美托咪定行SGB可有效减轻CO_2气腹患者的应激反应,维持循环稳定;单纯右美托咪定0.5μg/kg SGB并不能有效降低CO_2气腹患者的应激反应。Objective To invetstigate the effects of stellate ganglion block（SGB） with lidocaine combined with dexmedetomidine on stress response in the patients with CO2 pneumoperitoneum under general anesthesia. Methods Seventy-one patients undergoing laparoscopic cholecystectomy were randomly divided into 4 groups. SCJB on the right side was performed soon after intubation, which was with 1% lidocaine combined with dexmedetomidine 0.5 μg/kg in group LD（19 cases）, dexmede-tomidine 0. 5 μg/kg in group D（18 cases）, 1% lidocaine in group L（19 cases） and normal saline in group C（15 cases）. The volume of drugs for SGB was 8 ml. MAP and HR were recorded and plasma concentrations of cortisol（Cor）, epinephrine （E）, norepinephrine （NE） and dopamine （D） were detected by Roche electrochemical luminescence instrument and enzyme standard instrument befor anesthesia induction（T0）, at 5 minutes after SGB（T1）, 10 minutes during pneumoperitoneum（T2） and the end of surgery（T3）. Results MAP of 4 groups was lower at T1 than that at T0（P〈0. 05）. HR of groups of LD and L was slower at T1 than that at T0（P〈0. 05）. MAP and HR of groups of D and C were higher at T2 than those at TI（P〈0. 05）,which were higher in groups of LD and L at T2 than those at T1 and lower in groups of LD and L than those in groups of C and D（P〈0. 05）. Plasma concentrations of Cor, E, NE and D in four groups were higher at T2 and T3 than those at TO （P〈0. 05） ,which were lower in groups of LD and L than those in groups of C and D（P〈0. 05）. Conclusion Right SGB with lidocaine or lidocaine combined with dexmedetomidine,but not dexmede- tomidine, can effectively attenuate the stress response in the patients with CO2 pneumoperitoneum.

关 键 词：星状神经节阻滞 右美托咪定 二氧化碳气腹 应激 

分 类 号：R614[医药卫生—麻醉学]