右美托咪定对全身麻醉腹腔探查期间血流动力学指标影响  

Clinical research of dexmedetomidine on hemodynamic during abdominal exploration under general anesthesia

作　　者：马钰 陆敏敏 郑栋煜 李永华[2] 羊黎晔[2] MA Yu;LU Min-min;ZHENG Dong-yu;LI Yong-hua;YANG Li-ye(Department of Anesthesiology,Shanghai Baoshan Traditional Chinese Medicine-integrated Hospital,Shanghai 201999,China;Department of Anesthesiology,Shanghai Changzheng Hospital,Shanghai 200003,China)

机构地区：[1]上海市宝山区中西医结合医院麻醉科,上海201999 [2]上海长征医院麻醉科,上海200003

出　　处：《临床军医杂志》2020年第3期250-252,256,共4页Clinical Journal of Medical Officers

基　　金：国家自然科学基金面上项目(81671304);上海市卫生健康委先进适宜技术推广项目(2019SY019)。

摘　　要：目的探讨右美托咪定对全身麻醉腹腔探查期间血流动力学的影响。方法选取2017年1—8月拟在第二军医大学长征医院普外科择期行胃癌根治术的58例患者为研究对象,将所有患者随机分为A组(n=28)与B组(n=30)。给予B组患者静脉负荷剂量右美托咪定0.6μg/kg,然后0.2μg/kg/h维持到手术结束;A组患者泵注等量的生理盐水。比较两组患者腹腔探查期间高血流动力学事件发生率、术中舒芬太尼用量、术后拔管时间以及入室时(T0)、切开腹膜时(T1)、腹腔探查5 min(T2)、腹腔探查10 min(T3)、腹腔探查15 min(T4)时的心率(HR)和收缩压(SBP)。结果A组患者术中舒芬太尼用量、高血流动力学事件发生率、拔管时间均明显高于B组,两组比较,差异有统计学意义(P<0.05)。B组患者T2、T3、T4的HR和SBP均明显低于A组,两组比较,差异有统计学意义(P<0.05)。A组患者T2、T3、T4的HR和SBP均明显高于T1,差异有统计学意义(P<0.05)。结论右美托咪定可以有效抑制普外手术腹腔探查期间的高血流动力学反应,减少阿片类药物的应用。Objective To investigate the effect of dexmedetomidine on hemodynamic during abdominal exploration under general anesthesia.Methods A prospective study was performed on 58 patients who underwent scheduled gastrectomy from January to August 2017.All patients were randomly divided into the Group A(n=28)and Group B(n=30).Patients in Group B were given intravenous loading dose of dexmedetomidine at 0.6g/kg and 0.2g/kg/hour for maintenance until the end of surgery.Patients in Group A were pumped with the same amount of normal saline.Compare the incidence of positive hemodynamic response during abdominal exploration,the dosage of intraoperative sufentanil,postoperative extubation time,heart rate(HR)and systolic blood pressure(SBP)at baseline(T0),peritoneum incision(T1),abdominal exploration for 5 minutes(T2),abdominal exploration for 10 minutes(T3)and abdominal exploration for 15 minutes(T4).Results Intraoperative sufentanil dosage,high incidence of hemodynamic events and extubation time in Group A were significantly higher than those in Group B,with statistically significant differences(P<0.05).The HR and SBP of T2,T3 and T4 in Group B were significantly lower than those in Group A(P<0.05).In Group A,the HR and SBP of T2,T3 and T4 were significantly higher than T1(P<0.05).Conclusion Dexmedetomidine can effectively inhibit the high hemodynamic response during abdominal exploration and reduce the dosage of opioids.

关 键 词：右美托咪定 腹腔探查 血流动力学 

分 类 号：R614[医药卫生—麻醉学]