盐酸右美托咪定对地氟醚引起的交感兴奋作用的影响  

The effects of dexmedetomidine on desflurane-mediated sympathoexcitation

作　　者：刘畅 张茂银 陈雅洁 徐超 齐敦益 LIU Chang;ZHANG Maoyin;CHEN Yajie;XU Chao;QI Dunyi(School of Anesthesiology,Xuzhou Medical University,Xuzhou,Jiangsu 221004,China;Department ofAnesthesiology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221000)

机构地区：[1]徐州医科大学麻醉学院,江苏徐州221004 [2]徐州医科大学附属医院麻醉科,江苏徐州221000

出　　处：《徐州医科大学学报》2020年第1期17-21,共5页Journal of Xuzhou Medical University

基　　金：江苏省自然科学基金面上项目(BK2018043450)。

摘　　要：目的观察右美托咪定对地氟醚介导的交感兴奋作用的影响。方法选择择期行胸外科手术患者60例(ASAⅠ—Ⅲ级),分为地氟醚组(C组)、右美托咪定复合地氟醚组(D组),各30例。C组入室后泵注0.1 ml/kg生理盐水,在麻醉诱导前10 min内泵完,后改为0.05 ml/(kg·h)的生理盐水维持。D组入室后泵注1.0μg/kg右美托咪定,在麻醉诱导前10 min内泵完,后改为0.5μg/(kg·h)的右美托咪定维持。采集给药前(T 0)以及地氟醚呼气末浓度达1.0最低肺泡有效浓度(MAC)后1、2、3、4、5 min(T1、T2、T3、T4、T5)时2组患者平均动脉压(MAP)、心率(HR)、心率变异性(HRV)、血儿茶酚胺浓度值。结果与T 0时点相比,C组T1~T5时点的MAP、HR、低频/高频比值(LF/HF)、肾上腺素(E)、去甲肾上腺素(NE)值均升高(P<0.05);D组T1~T5时点的MAP、HR、LF/HF、E、NE值与T 0时点相比差异无统计学意义(P>0.05);2组MAP、HR、LF/HF、E、NE值在T 0时点差异无统计学意义(P>0.05),在T 3、T 4时点差异有统计学意义(P<0.05),2组HR、LF/HF、E、NE值在T 5时点差异有统计学意义(P<0.05)。结论右美托咪定可抑制地氟醚介导的交感兴奋作用。Objective To investigate the effects of dexmedetomidine on desflurane-mediated sympathoexcitation.MethodsA total of 60 patients undergoing elective thoracic surgery,ASAⅠ-Ⅲ,were randomly divided into two groups:desflurane group(Group C)and dexmedetomidine combined with desflurane group(Group D).Patients in Group C were treated with 0.1 ml/kg of normal saline within 10 min before induction of anesthesia,then the dose was changed to 0.05 ml/(kg·h)of normal saline.Patients in Group D were treated with 0.5μg/kg dexmedetomidine within 10 min before induction of anesthesia,then the dose was changed to 0.5μg/(kg·h)of dexmedetomidine.Mean arterial pressure(MAP),heart rate(HR),heart rate variability(HRV),levels of plasma norepinephrine(NE)and epinephrine(E)were recorded after entering the operating room(T0)and at 1 min,2 min,3 min,4 min,5 min(T 1,T2,T3,T4,T5)after the concentration of desflurane reaching 1.0 minimum alveolar concentration(MAC).ResultsThe MAP,HR,ratio of low frequency to high frequency(LF/HF),levels of plasma E and NE from T 1 to T 5 in Group C were higher than those of the T 0 time point(P<0.05).The differences of MAP,HR,LF/HF,levels of plasma E and NE from T1 to T5 in Group D were not statistically significant(P>0.05).The differences of MAP,HR,LF/HF,levels of plasma E and NE at T 0 time point were not statistically significant between Group C and Group D(P>0.05),while the differences were statistically significant between the two groups at T3 and T4 time points(P<0.05).The differences of HR,LF/HF,levels of plasma E and NE at T 5 was statistically significant between the two groups(P<0.05).Conclusions Dexmedetomidine can inhibit desflurane-mediated sympathoexcitation,which is beneficial for maintaining perioperative hemodynamic stability and reducing perioperative complications.

关 键 词：右美托咪定 地氟醚 交感兴奋 

分 类 号：R614.2[医药卫生—麻醉学]