蛛网膜下腔注射右美托咪定对肛周疾病手术患者应激反应的影响  

Influence of Subarachnoid Cavity Injecting Dexmedetomidine on the Stress Response of Patients Undergoing Perianal Disease Surgery

作　　者：宋晓阳[1] 姜万维[1] 王庆辉[1] 许民[1] 段海霞[1] 于学美[1] 

机构地区：[1]大连大学附属中山医院麻醉二部,辽宁大连116001

出　　处：《中国肛肠病杂志》2017年第2期15-19,共5页Chinese Journal of Coloproctology

摘　　要：为探讨蛛网膜下腔注射右美托咪定对椎管麻醉下行肛周疾病手术治疗的患者术中及术后应激反应的影响，本研究选择60例拟于联合阻滞麻醉下行肛周疾病手术治疗的患者进行研究，随机分为试验组和对照组，各30例。2组患者均取右侧卧位，取I或I腰椎间隙行联合阻滞麻醉，蛛网膜下腔用药情况：对照组应用重比重0．5％罗哌卡因10mg，试验组应用重比重0．5％罗哌卡因10mg和4μg右美托咪定。统计2组患者麻醉前（T1）、椎管内给药后10min（T2）、手术开始（T3）及术毕（T4）的平均动脉压（MAP）和心率（HR）；分别于麻醉前（T1）、术毕（T4）以及麻醉后24h（T0）采集患者静脉血，测量血浆血糖、血浆皮质醇及白介素6（IL-6）浓度；统计术中出现的不良反应，并进行对比分析。结果显示，2组患者T1～T4各时段间MAP和HR比较，差异均无统计学意义，P〉0．05；但试验组较对照组MAP总体偏低且更为平稳。在T1、T4两个时段，2组血浆血糖、皮质醇、IL-6水平并无明显差别，而在T。时段各指标试验组明显低于对照组，差异有统计学意义，P〈0．05。试验组患者麻醉后未出现寒战、恶心呕吐现象，对照组2例患者出现寒战，无出现恶心呕吐症状的患者。结果表明，蛛网膜下腔麻醉辅助应用右美托咪定对肛周疾病术中应激反应无明显影响，但可明显降低术后应激反应。To explore the influence of subarachnoid cavity injecting dexmedetomidine（DEX） on the intra- and post-operative stress response of patients undergoing perianal disease surgery under intraspinal anes- thesia,this study selected 60 cases with perianal disease to be subjected to above surgery and randomly di- vided them into trial group and control one,30 cases for each;made the patients of two groups to set right deeubitus position and performed associated block anesthesia on them at T4 or T 3 spinal diastem in which the subarachnoid cavity using drugs was： in control group, hyperbaric 0.5% ropiracaince of 10 mg;in trial group,same ropiracaine and 4μg DEX;then,the MAP and HR were recorded at T1 （before anesthesia）,Te （10 min after administered drugs via spinal canal）,Ta （operation starting） and T4 （the end of operation）; patient＇s venous blood was sampled at T ,T and T （24 h after anesthesia） respectively for detecting the levels of plasma glucose and cortisol,as well of IL-6 ;what＇s more,observed adverse reaction during opera tion,and compared analyzed.As results,at T-T/ in MAP and HR there was all no statistical difference （ P 0.05）,but in trial group whole MAP was lower and more stable than in control group;at T1 and T4 time intervals the levels of plasma glucose and cortisol,as well of IL-6 had no significant difference between two group＇s, but at T time interval above levels of trial group was significantly lower than control group, there was statistical difference （ P 0.05）;as for adverse reactions,after anesthesia the patients of trial group had no ague, nausea and vomiting, while in control group only 2 cases suffered from ague, had no nausea and vomiting.Results show that subarachnoid cavity anesthesia added injecting DEX does no influ- ence intraoperative stress response of patients undergoing perianal disease surgery, instead, can significantly reduce incidence of postooerative stress resnonse.

关 键 词：肛周疾病 手术 右美托咪定 蛛网膜下腔 椎管麻醉 应激反应 

分 类 号：R719.8[医药卫生—妇产科学]