右美托咪定对肺癌切除术患者应激反应的影响  

The Influence of Dexmedetomidine on Stress Reaction in Patients with Lung Cancer Resection by the Thoracoscope

作　　者：幸泽艇 王梅 王万辉[2] 钟钦文[2] 巫光华[2] 钟玉婷[2] 叶军明[2] XING Zeting;WANG Mei;WANG Wanhui;ZHONG Qinwen;WU Guanghua;ZHONG Yuting;YE Junming(Fraternity Hospital of Zhongshan City,Zhongshan 528400,China)

机构地区：[1]广东省中山市博爱医院,广东中山528400 [2]赣南医学院第一附属医院

出　　处：《中国医学创新》2019年第34期5-11,共7页Medical Innovation of China

基　　金：江西省赣州市科技局项目(GZ2015ZSF096)

摘　　要：目的:观察在胸腔镜肺癌切除术中运用右美托咪定(DEX)对围术期患者应激反应的影响。方法:选择胸外科住院的非小细胞性肺癌患者,随机分C组(生理盐水)和DEX组(右美托咪定),双盲隐藏,各组均60例。DEX组麻醉诱导前10 min开始给予负荷量0.5μg/kg泵注,后给予维持剂量为0.6μg/(kg·h)。观察并记录患者入手术室时(T0)、插管后即刻(T1)、切皮时(T2)、肿瘤切除后即刻(T3)、拔管后即刻(T4)、拔管后30 min(T5)的SBP、DBP和HR,并在T0~T5各时间点抽静脉血5 mL检测NE、E、CRH、Glu,观察苏醒时间、拔管时间及VAS和苏醒期躁动、寒战的发生情况。结果:DEX组的SBP、DBP、HR、NE、E、CRH、Glu均显著低于C组(P<0.01)。T1~T5时C组DBP、HR、NE、E、CRH、Glu显著高于T0(P<0.01),T1~T3、T5时DEX组DBP、HR低于T0(P<0.05),T4时DEX组DBP、HR高于T0(P<0.05)。与C组比较,DEX组苏醒时间、拔管时间无明显差异(P>0.05),而VAS更低(P<0.05),躁动、寒战发生率更低、程度更轻(P<0.05)。结论:右美托咪定使围术期血流动力学波动小,抑制神经内分泌激素分泌,苏醒期不良反应小,不影响苏醒及拔管。Objective: To study the influence of Dexmedetomidine(DEX) on stress reaction in patients with lung cancer resection by the thoracoscope. Method: The total of 120 patients with lung cancer in hospital were selected according to the inclusion and exclusion criteria who signed the informed consent forms, they were randomly distributed to two groups: group C(n=60) and group DEX(n=60) with double blind. Group C was given normal saline, group DEX was given Dexmedetomidine. All patients were received intravenously at a rate of 0.5 μg/kg10 min prior to the onset of anesthesia induction, and then maintained with the dose of 0.6 μg/(kg·h). The SBP, DBP, HR, NE, E, CRH and Glu, awake time and extubate time, VAS and the incidence and degree of agitation and shiver happened in the T0, T1, T2, T3, T4 and T5 were observed and recorded. Result: Compared with group C, the levels of SBP, DBP, HR, NE, E, CRH and Glu of DEX group were significantly lower(P<0.01). The levels of DBP, HR, NE, E, CRH, Glu at T1-T5 in group C were significantly higher than those of T0(P<0.01), DBP and HR at T1-T3 and T5 in DEX group were lower than those of T0(P<0.05), DBP and HR at T4 in DEX group were higher than those of T0(P<0.05).Compared with group C, the difference of wake up time and extubate time in group DEX was not statistical different(P>0.05), but VAS decreased more(P<0.05). Compared with group C, the incidence and degree of agitation and shiver happened in group DEX was respectively lower and lighter(P<0.05). Conclusion: Dexmedetomidine reduces hemodynamic fluctuation during perioperative period, inhibits neuroendocrine hormone secretion, has little adverse reactions during waking period, and does not affect waking and extubation.

关 键 词：右美托咪定 应激 去甲肾上腺素 促肾上腺皮质激素释放激素 糖皮质激素 

分 类 号：R614[医药卫生—麻醉学]