右美托咪定抑制老年患者胸腔镜辅助肺叶切除术拔管期应激反应的效果观察  

The Inhibitory Effect of Dexmedetomidine on Stress Response during Extubation after Video-assisted Lobectomy in Elderly Patients

作　　者：石伟[1] 徐明禹 罗耀文[1] 何建斌 丁登峰[1] SHI Wei;XU Ming -yu;LUO Yao-wen;HE Jian-bin;DING Deng-feng(Department of Anesthesiology,Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, Guangdong Shenzhen 518020, China)

机构地区：[1]深圳市人民医院暨南大学医学院第二附属医院麻醉科,广东深圳518020

出　　处：《广东医学》2019年第6期791-794,共4页Guangdong Medical Journal

基　　金：广东省医学科研基金资助项目(编号:A2017597);深圳市卫生计生系统科研项目(编号:201501005)

摘　　要：目的研究右美托咪定对老年患者胸腔镜辅助肺叶切除术拔管期应激反应的影响。方法拟行胸腔镜辅助下肺叶切除术的老年患者60例,随机分为对照组和观察组,每组30例,所有患者均采用气管插管全麻,观察组关胸时,15 min内静脉输注右美托咪定0.5μg/kg,对照组输注等剂量生理盐水。记录手术时间、拔管时间、麻醉诱导前(T1)、拔出气管导管即刻(T2)、拔出气管导管后5 min(T3)、10 min(T4)的心率(HR)和平均动脉压(MAP)及各时点血浆肾上腺素(E)、去甲肾上腺素(NE)和皮质醇(Cor)浓度,观察拔管期呛咳反应、躁动评分、OAA/S评分、视觉模拟评分(VAS),记录不良反应发生率。结果对照组T2～T4时点HR、MAP和血浆E、NE、Cor水平高于T1(P<0.05),观察组T2时点MAP和血浆E、NE、Cor水平高于其他时点(P<0.05);观察组T2～T4时点HR、MAP和血浆E、NE、Cor水平低于对照组(P<0.05);观察组呛咳反应和VAS数值低于对照组(P<0.05);拔管期观察组高血压发生率低于对照组(P<0.05)。结论 0.5μg/kg右美托咪定用于老年患者胸腔镜辅助肺叶切除术拔管,可有效抑制拔管期应激反应,维持血流动力学平稳,减轻呛咳反应,提高术后镇痛质量。Objective To investigate the effects of dexmedetomidine on stress response during extubation after video-assisted lobectomy in elderly patients. Methods Sixty elderly patients underwent video-assisted lobectomy were randomly divided into control group and observation group(n=30). All patients were given with general anesthesia. Observation group received intravenous injection of dexmedetomidine(0.5 μg/kg) 15 minutes before the closure of the chest. Control group received the same dose of normal saline. The operation time and extuabtion time were recorded. HR, MAP and the plasma concentrations of epinephrine, norepinephrine and cortisol were determined before anesthesia(T1), at extubation(T2), and 5 min(T3) and 10 min(T4) after extubation. The cough, agitation grade, OAA/S scale and VAS, and the incidences of adverse reactions were also observed during extubation. Results HR, MAP and the plasma concentrations of epinephrine, norepinephrine and cortisol at T2-T4 were significantly higher than those at T1 in control group(P<0.05). MAP and the plasma concentrations of epinephrine, norepinephrine and cortisol at T2 were significantly higher than those at T1, T3 and T4 in observation group(P<0.05). At T2, T3 and T4, HR, MAP and the plasma concentrations of epinephrine, norepinephrine and cortisol of observation group were significantly lower than those of control group(P<0.05). Compared with control group, the cough and VAS were significantly better and the incidence of hypertension was significantly lower in observation group(P<0.05). Conclusion Intravenous injection of dexmedetomidine for extubation after video-assisted lobectomy can suppress stress response, maintain stable hemodynamics, attenuate cough and improve analgesia quality in elderly patients.

关 键 词：右美托咪定 胸腔镜辅助肺叶切除术 老年人 应激反应 

分 类 号：R971.2[医药卫生—药品] R563[医药卫生—药学]