右美托咪定对老年腹腔镜胆囊切除术患者肝肾功能的保护  

Protection effect of dexmedetomidine on liver and kidney function during laparoscopic cholecystec-tomy in elderly patients

作　　者：吴亮春[1] 汤洁[1] 邵永斌[1] 

机构地区：[1]武警安徽总队医院麻醉科,合肥230041

出　　处：《中国实用医刊》2016年第16期44-47,共4页Chinese Journal of Practical Medicine

摘　　要：目的：研究右美托咪定对老年腹腔镜胆囊切除术患者肝肾功能的保护。方法选取2014年4月至2015年3月行腹腔镜胆囊切除术的76例患者。根据抽签法分为试验组和对照组，每组38例。试验组在诱导前静脉泵注右美托咪定0.50μg/kg，10 min泵完，对照组使用同等剂量氯化钠注射液。比较两组患者在手术前、手术结束后血浆皮质醇、去甲肾上腺素、肾上腺素、心率、呼吸频率、动脉压及肝、肾功能指标变化情况。结果试验组拔管后躁动发生率[7.89％（3/38）]明显低于对照组[28.95％（11/38）]，差异有统计学意义（ P﹤0.05）。术前术后，两组患者丙氨酸氨基转移酶、间接胆红素、直接胆红素、肌酐水平比较差异未见统计学意义（ P﹥0.05）。术后，试验组尿素氮[（3.24±0.31）mmol/L]低于对照组[（4.67±0.52）mmol/L]，血糖水平[（5.46±0.54）mmol/L]波动幅度低于对照组[（6.73±0.63）mmol/L]，两组比较差异有统计学意义（P﹤0.05）。术后，试验组的血浆皮质醇、去甲肾上腺素、肾上腺素水平为（451.46±37.14）μmol/L、（122.97±12.43）nmol/L、（5.42±0.53）nmol/L，明显低于对照组的（573.24±40.11）μmol/L、（162.76±16.43）nmol/L、（6.74±0.68）nmol/L，差异有统计学意义（P﹤0.05）。术后，试验组的心率、动脉压[（86.32±8.98）次/min、（83.24± 8.13）mmHg（1 mmHg＝0.133 kPa）]波动幅度低于对照组[（97.13±10.22）次/min、（89.45±9.45）mmHg]，差异有统计学意义（ P﹤0.05）。结论老年腹腔镜胆囊切除术患者全身麻醉过程中使用右美托咪定，可明显抑制应激反应，对肝肾功能起保护性作用。Objective To study the protection effect of dexmedetomidine on liver and kidney function during laparoscopic cholecystectomy in elderly patients. Methods From April 2014 to March 2015,76 patients with laparoscopic cholecystectomy were selected. According to the draw method,the patients were divided into experiment group and control group,with 38 cases in each group. The patients in experiment group were given dexmedetomidine 0. 50 μg/kg for induction of anesthesia,and the pa-tients in control group were given 1 μg/（ kg＆#183;h）physiological saline for induction of anesthesia. Before and after operation,the levels of plasma cortisol,norepinephrine,epinephrine,heart rate,breathing rate,mean arterial pressure,and liver and kidney function index changes in the two groups were com-pared. Results The extubation agitation rate in the experiment group was 7. 89%（3/38）,which was significantly lower than that in the control group[28. 95%（11/38）],P﹤0. 05. There was no signifi-cant difference in the preoperative and postoperative ALT,indirect bilirubin,direct bilirubin and creati-nine（P﹥0. 05）. After operation,the nitrogen[（3. 24 ± 0. 31）mmol/L]in the experiment group was lower than that in the control group[（ 4. 67 ± 0. 52 ） mmol/L ], blood glucose levels [（ 5. 46 ± 0. 54）mmol/L]was lower than that in the control group[（6. 73 ± 0. 63）mmol/L],P﹤0. 05. After oper-ation,the plasma cortisol,norepinephrine,adrenaline levels in the experiment group was（ 451. 46 ± 37. 14）μmol/L,（122. 97 ± 12. 43）nmol/L,（5. 42 ± 0. 53）nmol/L,which was significantly lower than those in the control group[（573. 24 ± 40. 11）μmol/L,（162. 76 ± 16. 43）nmol/L,（6. 74 ± 0. 68）nmol/L],the differences were significant（P﹤0. 05）. After operation,the heart rate,mean ar-terial pressure[（86. 32 ± 8. 98）times/min,（83. 24 ± 8. 13）mmHg]fluctuation amplitude in the ex-periment group were lower than those in the control group[（ 97. 13 ± 10. 22 ）times/min,（ 89. 45 ± 9. 45

关 键 词：右美托咪定 腹腔镜手术 肝肾功能 

分 类 号：R657.4[医药卫生—外科学]