盐酸右美托咪定对重症肌无力手术患者血流动力学及炎性因子的影响  

Effects of dexmedetomidine hydrochloride on hemodynamics and inflammatory factors in patients with myasthenia gravis

作　　者：邱延伟 杨艳超[1] 李延峰[1] QIU Yanwei;YANG Yanchao;LI Yanfeng(The First Hospital of Shijiazhuang City,Hebei,Sjijiazhuang 050011,China)

机构地区：[1]河北省石家庄市第一医院,050011

出　　处：《河北医药》2018年第20期3058-3063,共6页Hebei Medical Journal

基　　金：河北省科技计划项目(编号:162777158)

摘　　要：目的探讨不同剂量的盐酸右美托咪定对重症肌无力手术患者血流动力学及炎性因子的影响。方法选取择期行胸腔镜下胸腺切除术的重症肌无力患者40例,入选标准:ASA分级Ⅰ~Ⅱ级,年龄18~65岁,性别不限,根据盐酸右美托咪定(DEX)术中持续泵入速度的不同,将研究对象随机分为4组:0. 9%氯化钠溶液对照组(C组)、0. 2μg·kg^(-1)·h^(-1)DEX组(D1组)、0. 4μg·kg^(-1)·h^(-1)DEX组(D2组)、0. 6μg·kg^(-1)·h^(-1)DEX组(D3组),每组10例。D1组、D2组、D3组在麻醉诱导前10 min静脉输注DEX 1μg/kg,随后分别以0. 2μg·kg^(-1)·h^(-1)、0. 4μg·kg^(-1)·h^(-1)、0. 6μg·kg^(-1)·h^(-1)输注至手术结束,C组0. 9%氯化钠溶液对照。全麻诱导后,泵入丙泊酚3~5 mg·kg^(-1)·h^(-1),盐酸瑞芬太尼0. 1~0. 2μg·kg^(-1)·h^(-1),间断静脉注射顺阿曲库铵,维持BIS值于40~60。以上4组患者分别于麻醉前(T0)、插管即刻(T1)、单肺通气30 min(T2)、单肺通气90 min(T3)、术后2 h(T4)记录平均动脉压(MAP)和心率(HR),记录心血管不良反应发生率(MAP <70 mm Hg或HR <50次/min),T0、T1、T2、T3、T4点抽取颈内静脉血5 ml,采用酶联免疫吸附法测血清肿瘤坏死因子(TNF-α)、白细胞介素-6(IL-6)水平。结果 4组患者的一般情况(年龄、性别、BIS、ASA、补液量、出液量、手术时长)比较差异无统计学意义(P> 0. 05)。血流动力学指标HR:与C组比较,D2组T4时HR明显降低(P <0. 05),D3组T3、T4时HR明显降低(P <0. 05);与D1组比较,D2组T4时HR明显降低(P <0. 05),D3组T3、T4时HR明显降低(P <0. 05);与D2组比较,D3组T3、T4时HR明显降低(P <0. 05)。与T0比较,T3时D3组HR明显降低(P <0. 05); T4时C组、D1组HR明显增高(P <0. 05)。MAP:与C组比较,D2组T4时MAP明显降低(P <0. 05),D3组T2、T3、T4时MAP明显降低(P <0. 05);与D1组比较,D2组T4时MAP明显降低(P <0. 05),D3组T2、T3、T4时MAP明显较低(P <0. 05);与D2组比较,D3组T2、T3、T4时MAP明显降低(P <0. 05)。与T0比�Objective To investigate the effects of different doses of dexmedetomidine hydrochloride （DEX） on hemodynamics and inflammatory factors in patients with myasthenia gravis. Methods Forty patients with myasthenia gravis who underwent elective thoracoscopic thymectomy were enrolled in our study. The inclusion criteria were as follows： the American Society of anesthesiologists （ASA） grade Ⅰ-Ⅱ, aged 18-65 years, and male or female. According to different continuous intravenous pumping speed of DEX, the patients were randomly divided into four groups： saline control group （group C）, 0.2μg·kg^-1·h^-1DEX group （group D1）, 0.4μg·kg^-1·h^-1DEX group （group D2）, and 0.6μg·kg^-1·h^-1DEX group （group D3）, with 10 cases in each group. The patients in group D1, D2 and D3 were intravenously infused with DEX 1 μg/kg 10 min before anesthesia induction, followed by 0.2μg·kg^-1·h^-1and 0.4μg·kg^-1·h^-1, and 0.6μg·kg^-1·h^-1, respectively until the end of surgery. Those in group C were given 0.9% sodium chloride solution as control group. After induction of general anesthesia, propofol 3-5mg·kg^-1·h^-1and remifentanil hydrochloride 0.1- 0.2μg·kg^-1·h^-1were pumped in, accompanied by intermittent injection of cis-atracurium, maintaining a BIS value between 40 and 60. Mean arterial pressure （MAP）, heart rate （HR）, the incidence of cardiovascular adverse reactions （MAP〈70mm Hg or HR〈50 times/min） were recorded in the above groups before anesthesia （T0）, immediate intubation （T1）, 30 min after single-lung ventilation （T2）,80 min after single-lung ventilation （T3）, and at 2 h after surgery （T4）. Internal jugular vein blood （5 ml） was collected at T0, T1, T2, T3, and T4. Serum tumor necrosis factor （TNF-α） and interleukin-6 （IL-6） levels were measured by enzyme-linked immunosorbent assay （ELISA）. Results There was no significant difference in the general condition （age, gender, BIS, ASA, rehydration fluid, fluid output, duratio

关 键 词：重症肌无力 盐酸右美托咪定 胸腔镜下胸腺切除术 血流动力学 炎性因子 

分 类 号：R746.1[医药卫生—神经病学与精神病学]