右美托咪定与利多卡因预处理对全麻诱导时依托咪酯不良反应的影响  

Effect of dexmedetomidine and lidocaine pretreatment on adverse reactions of etomidate during general anesthesia induction

作　　者：张宁 张爱民[1] 王冉[1] 陈杰[1] ZHANG Ning;ZHANG Aimin;WANG Ran;CHEN Jie(Department of Anesthesiology,Affiliated Hospital of Hebei University of Engineering,Handan,Hebei 056002,China)

机构地区：[1]河北工程大学附属医院麻醉科,河北邯郸056002

出　　处：《安徽医药》2021年第1期152-155,共4页Anhui Medical and Pharmaceutical Journal

基　　金：邯郸市科学技术研究与发展计划(1623208065⁃3)。

摘　　要：目的观察右美托咪定与利多卡因预处理对全身麻醉诱导期依托咪酯注射痛及肌阵挛的影响。方法选择2018年6月至2019年6月河北工程大学附属医院择期手术全麻病人144例,ASA分级Ⅰ~Ⅱ,采用随机数字表法分为三组:对照组(C组)、右美托咪定组(D组)、利多卡因组(L组),每组48例。D组和L组病人分别预先泵注右美托咪定0.5μg/kg和利多卡因1mg/kg;C组给予等容量0.9%氯化钠溶液(10 mL),均在10 min注射完毕。然后各组病人静脉推注依托咪酯0.3 mg/kg,注射时间30 s。分别干预给药前(T0)、给依托咪酯前(T1)、及给依托咪酯后1 min(T2)、2 min(T3)记录病人HR(心率)、MAP(平均动脉压)、SpO2(血氧饱和度)、镇静评分,并记录注射痛、低血压和心动过缓发生率,评估肌阵挛发生情况及严重程度。结果与C组比较,D组和L组的肌阵挛发生率明显降低(P<0.05);而D组与L组之间肌阵挛发生率及程度差异无统计学意义。D组镇静评分明显高于C组和L组(P<0.05);与C组比较,D组和L组的注射痛发生率明显降低(P<0.05);而D组与L组之间注射痛发生率差异无统计学意义。各组均无低血压和心动过缓发生。D组和L组MAP均在T1(79.5±6.4)、T2(74.8±5.8)、T3(66.9±5.4)mmHg逐渐降低;C组和L组HR均在T1(74.3±3.7)、T2(79.0±3.5)、T3(84.3±3.1)次/分钟逐渐升高;三组MAP和HR组间、时点间和组间×时点间交互作用均差异有统计学意义(P<0.05)。三组SpO2组间、时点间和交互作用均差异无统计学意义(P>0.05)。结论右美托咪定与利多卡因预处理,均可减少麻醉诱导期依托咪酯所致的肌阵挛及注射痛的发生;与利多卡因相比,右美托咪定可提供更稳定的血流动力学。Objective To observe the effect of dexmedetomidine and lidocaine pretreatment on injection pain and myoclonus of etomidate during general anesthesia induction.Methods From June 2018 to June 2019,144 patients(ASAⅠ~Ⅱ)had surgery during this period were randomly divided into3 groups(N=48):control group(Group C),Dex group(Group D),and lidocaine group(Group L)by random number table method.Patients in Group D and Group L received intravenous Dex 0.5μg/kg and lidocaine 1 mg/kg respectively,while patients in group C received intravenous normal saline with the same volume(10 m L)within10 min.Then etomidate 0.3 mg/kg was injected intravenously for 30 s.Heart rate(HR),mean arterial pressure(MAP),oxygen saturation(SpO2)and Ramsay score were recorded before drug(T0),to etomidate before(T1)and to 1 min(T2),2 min(T3)after etomidate.The adverse effects such as injection pain and adverse cardiovascular events were also recorded.The onset of myoclonus was observed and the severity was recorded.Results Compared with group C,the incidence of myoclonus in group D and group L was significantly lower(P<0.05),but there was no significant difference in the incidence and degree of myoclonus between group D and group L.Sendation score in Group D was significantly higher than the other two groups(P<0.05).Comparing to group C,the incidence of pain in Group C was significantly higher than that in Group L and Group D(P<0.05).The frequency of etomidate injection pain were statistically similar between Group L and Group D.No hypotension and bradycardia occurred in all groups.The groups D and groups L of MAP were gradually lower at T1(79.5±6.4),T2(74.8±5.8),T3(66.9±5.4)mmHg time point;The groups C and groups L of HR were gradually higher at T1(74.3±3.7),T2(79.0±3.5),T3(84.3±3.1)bpm time point.In MAP and HR,interblock、time dissimilarity and interaction of interblock with time dissimilarity of the three groups had statistically significant difference(P<0.05).For SpO2,there was no significant difference among the three groups(P>0.05).Co

关 键 词：依托咪酯 药物相关性副作用和不良反应 麻醉 全身 右美托咪定 利多卡因 肌阵挛 注射痛 

分 类 号：R614.2[医药卫生—麻醉学]