低剂量右美托咪定对腹腔镜下子宫切除术患者麻醉效果及对其应激水平和微循环的影响研究  

Low-dose dexmedetomidine in patients given laparoscopic hysterectomy effects and impact on stress level and microcirculation observation

作　　者：刘洋[1] 孙晓川[2] Liu Yang;Sun Xiaochuan(Panzhihua City,Sichuan Province Central Hospital Anesthesiology（Panzhihua 617000)

机构地区：[1]四川省攀枝花市中心医院麻醉科,攀枝花617000 [2]重庆医科大学附属第一医院,重庆400016

出　　处：《陕西医学杂志》2018年第12期1536-1540,共5页Shaanxi Medical Journal

基　　金：国家自然科学基金资助项目(30973087)

摘　　要：目的:观察持续低剂量右美托咪定对腹腔镜下子宫切除术患者应激水平及微循环的影响。方法:选择择期行腹腔镜子宫切除术的患者120例,随机分为两组各60例。观察组给予低剂量右美托咪定0.4μg/(kg·h)静脉泵入,术中予静滴咪达唑仑、芬太尼、丙泊酚、七氟醚麻醉。对照组予0.9%氯化钠注射液(具体用法用量与观察组相同),余术中麻醉与观察组相同。观察两组患者麻醉插管前(T_1)、插管后(T_2)、手术时(T_3)、术毕(T_4)和拔管后(T_5)的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)、经皮氧分压(TcPO_2)、经皮二氧化碳分压(TcPCO2)、血乳酸(Lac)数值以及在所有患者插管前(T_1)、插管后(T_2)、拔管后(T_5)即刻抽取3ml静脉血以测血中皮质醇(Cor)、肾上腺素(E)、去甲肾上腺素(NE)以及β-内啡肽的浓度。并观察手术后、拔出气管导管时、拔出气管导管1h后患者视觉模拟评分(VAS)。结果:与对照组相比,除T1时刻外,观察组在T2、T3和T4时刻的SBP、DBP、MAP和HR均明显较低,差异均具有统计学意义(P<0.05);两组同时间点TcPCO_2差异无统计学意义(P>0.05),不同时间点Lac呈现上升趋势,但两组之间各时间点Lac水平差异无统计学意义(P>0.05),与对照组比较,TcPO2差异有统计学意义P<0.05),呈上升趋势;与对照组相比,观察组在T_1、T_2和T_5时刻的Cor、E、NE和β-内啡肽值均明显较低,差异均具有统计学意义(P<0.05);与对照组相比,观察组在术后各个时刻的VAS评分均明显较低,差异均具有统计学意义(P<0.05)。结论:低剂量的右美托咪定能维持手术期患者血流动力学稳定,降低手术期机体应激反应强度,从而进一步抑制其对靶器官血管平滑肌的影响。Objective： To observe the continuous low-dose dexmedetomidine definite impact on laparoscopic hysterectomy patients＇ stress levels and microcirculation. Methods：120 patients undergoing laparoscopic hysterectomy patients for the study were randomly divided into two groups of 60 cases. Observation group were given low doses of dexmedetomidine given 0.4μg /（kg· h） intravenous infusion, surgery to intravenous midazolam, fentanyl, propofol, sevoflurane anesthesia. In the control group to 0.9% sodium chloride injection （same dosage and usage specific study group）, more than the same anesthetic and the observation group. Were observed before anesthesia intubation （T 1）, after intubation （T 2）, the time of surgery （T 3）, surgery （T 4） and after extubation （T 5） systolic blood pressure （SBP）, diastolic blood pressure （DBP）, Mean arterial pressure （MAP）, heart rate （HR）,transcutaneous oxygen pressure（TcPO 2）,transcutaneous carbon dioxidepressure（TcPCO 2）,Lactate（Lac）and in all patients prior to intubation （T 1）, after intubation （T 2）, after extubation （T 5） immediately 3ml venous blood drawn to measure cortisol （Cor）, epinephrine （E）, norepinephrine （NE） and the concentration of β- endorphin. And observation after surgery, when removing the endotracheal tube, endotracheal tube pulled after 1h patient visual analog scale （VAS）. Results： Compared with the control group, in addition to the time T 1, the observation group were significantly lower in T 2, T 3 and T 4 time of SBP, DBP, MAP and HR, the differences were statistically significant （ P 〈0.05）;the two groups had no statistical significance at the same time, the difference of TcPCO 2 （ P 〉0.05）, Lac at different time points showed a rising trend, but no significant levels of Lac at each time point, the differences between the two groups （ P 〉 0.05）, compared with the control group, the difference was statistically significant TcPO 2 P 〈0.05）, is on the

关 键 词：右美托咪定 子宫切除术 腹腔镜检查 应激 生理性 微循环 麻醉和镇痛 

分 类 号：R614.2[医药卫生—麻醉学]