右美托咪定对脓毒症休克患者围术期血流动力学、乳酸清除率及肝肾功能的影响  

Effects of dexmedetomidine on perioperative hemodynamics,lactate clearance rate,and hepatic and renal function in patients with septic shock

作　　者：韦国温[1] 卢炳益[1] WEI Guo-wen;LU Bing-yi(Department of Anesthesiology,People’s Hospital of Baise,Baise 533000,China)

机构地区：[1]广西百色市人民医院麻醉科,百色市533000

出　　处：《广西医学》2020年第10期1219-1223,共5页Guangxi Medical Journal

摘　　要：目的比较丙泊酚与右美托咪定对行全身麻醉手术的脓毒症休克患者围术期血流动力学、乳酸清除率及肝肾功能的影响。方法将119例行全身麻醉手术的脓毒症休克患者随机分为丙泊酚组59例和右美托咪定组60例。丙泊酚组应用丙泊酚联合瑞芬太尼等药物进行麻醉,右美托咪定组应用右美托咪定联合瑞芬太尼等药物进行麻醉。记录两组患者诱导前(T0)、插管前(T1)、插管后(T2)、手术开始(T3)、手术15 min(T4)、手术30 min(T5)、手术结束(T6)时平均动脉压(MAP)、心率、心脏指数、中心静脉压(CVP),比较两组患者手术前后血乳酸水平、乳酸清除率、血清ALT、肌酐水平、麻醉过程中去甲肾上腺素用量,并分析两组患者呕吐及术后30 d死亡发生情况。结果在T1~T6,两组的MAP、心率均低于T0水平,而心脏指数、CVP均高于T0水平(均P<0.05);在T1、T2、T4、T6,右美托咪定组的MAP、心率均低于丙泊酚组(均P<0.05),而其余各时间点两组差异并无统计学意义(均P>0.05)。右美托咪定组去甲肾上腺素使用次数、用量均少于丙泊酚组,乳酸清除率高于丙泊酚组(均P<0.05)。术后两组患者血乳酸、ALT、肌酐水平均低于术前,且右美托咪定组低于丙泊酚组(均P<0.05)。两组患者术后呕吐发生率、术后30 d内病死率差异无统计学意义(均P>0.05)。结论右美托咪定在维持行全身麻醉手术的脓毒症休克患者围术期血流动力学指标稳定、提高乳酸清除率、改善肝肾功能等方面均优于丙泊酚。Objective To compare the effects of propofol versus dexmedetomidine on perioperative hemodynamics,lactate clearance rate,and hepatic and renal function in patients with septic shock undergoing general anesthesia surgery.Methods A total of 119 patients with septic shock undergoing general anesthesia surgery were randomly divided into propofol group(59 cases)and dexmedetomidine group(60 cases).The propofol group was anesthetized with propofol and remifentanil,whereas the dexmedetomidine group was anesthetized with dexmedetomidine and remifentanil.Before induction(T 0),before intubation(T 1),after intubation(T 2),at the beginning of operation(T 3),15 minutes after operation(T 4),30 minutes after operation(T 5),and at the end of operation(T 6),mean arterial pressure(MAP),heart rate,cardiac index,and central venous pressure(CVP)were recorded in both groups.Blood lactate level,lactate clearance rate,serum ALT and creatinine levels,and norepinephrine consumption during anesthesia were compared between the two groups before and after operation.The incidence of vomiting and 30-day death postoperatively were analyzed in the two groups.Results At T 1 to T 6,MAP and heart rate were lower while cardiac index and CVP were higher in both groups compared with those at T 0(all P<0.05);the dexmedetomidine group exhibited lower MAP and heart rate at T 1,T 2,T 4 and T 6 than the propofol group(all P<0.05),moreover,there was no statistically significant difference in MAP or heart rate between the two groups at other time points(all P>0.05).The dexmedetomidine group had few frequency and less consumption of norepinephrine use and higher lactate clearance rate than the propofol group(all P<0.05).The postoperative levels of blood lactate,ALT and creatinine were lower than the preoperative levels in the two groups,and the dexmedetomidine group had lower levels than the propofol group(all P<0.05).No statistically significant difference was found between the two groups in incidence rate of postoperative vomiting or 30-day morbidity postope

关 键 词：脓毒症休克 丙泊酚 右美托咪定 全身麻醉 血流动力学 乳酸清除 肝肾功能 

分 类 号：R614.2[医药卫生—麻醉学]