右美托咪定对肾上腺嗜铬细胞瘤切除术循环波动、麻醉深度、肌松及安全性作用  

Effects of different doses of dexmedetomidine on circulatory fluctuations,depth of anesthesia,muscle relaxation and safety in adrenal pheochromocytoma resection

作　　者：朱永霞[1] 孔莉[1] 朱照伟[2] Zhu Yongxia;Kong Li;Zhu Zhaowei(Department of Urology,Shangqiu First People’s Hospital,Shangqiu 476100,China;Department of Urology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]商丘市第一人民医院麻醉科,商丘476000 [2]郑州大学第一附属医院泌尿外科,郑州450003

出　　处：《中华内分泌外科杂志（中英文）》2024年第4期538-543,共6页Chinese Journal of Endocrine Surgery

基　　金：国家自然科学基金(81702503)。

摘　　要：目的探究不同剂量的右美托咪定(dexmedetomidine,DEX)对肾上腺嗜铬细胞瘤切除术中循环波动、麻醉深度、肌松及安全性的影响。方法选取2020年9月至2022年9月商丘市第一人民医院和郑州大学第一附属医院收治的78例行肾上腺嗜铬细胞瘤切除术患者,随机数字表法分为0.2μg组和0.4μg组,各39例。0.2μg组在全麻诱导前30 min给予0.2μg·kg^(-1)·h^(-1)DEX,0.4μg组在全麻诱导前30 min给予0.4μg·kg^(-1)·h^(-1)DEX,直至肿瘤血管完全钳闭。比较两组各时间循环波动[心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)、血氧饱和度(blood oxygen saturation,SpO2)]、麻醉深度[Narcotrend指数(NI)]、肌松效果、麻醉恢复情况[Ricker镇静-躁动评分(SAS评分)]、血管活性药物使用情况及安全性。结果0.4μg组麻醉诱导后、术毕HR分别为(92.73±9.58)次/min、(84.39±8.65)次/min,均低于0.2μg组的(103.57±6.91)次/min、(91.53±7.27)次/min;MAP分别为(85.30±4.29)mmHg、(80.45±6.38)mmHg,均低于0.2μg组的(96.35±5.88)mmHg、(84.92±5.19)mmHg;肿瘤切除后HR、MAP分别为(80.22±7.30)次/min、(77.46±7.10)mmHg,均高于0.2μg组的(75.14±5.82)次/min、(73.92±6.03)mmHg(P<0.05);0.4μg组气管插管后即刻NI为52.23±5.40,低于0.2μg组的58.78±5.92(P<0.05);0.4μg组起效时间为(91.00±10.00)s,早于0.2μg组的(105.00±12.00)s(P<0.05);0.4μg组气管拔管时SAS评分为5(4,5)分,低于0.2μg组的4(3,4)分(P<0.05);0.4μg组酚妥拉明、去甲肾上腺素、硝酸甘油用量分别为(2.64±0.35)mg、(60.42±8.57)μg、(102.00±12.31)μg·kg^(-1)·min^(-1),均低于0.2μg组的(3.79±0.44)mg、(78.70±10.28)μg、(113.25±19.67)μg·kg^(-1)·min^(-1)(P<0.05);0.4μg组不良反应总发生率与0.2μg组间差异无统计学意义(P>0.05)。结论肾上腺嗜铬细胞瘤切除术中应用0.2μg·kg^(-1)·h^(-1)和0.4μg·kg^(-1)·h^(-1)DEX均有较高的安全性,而后者麻醉效果较好,能减少血管活性药物剂量和复苏期躁动,�ObjectiveTo investigate the effects of dexmedetomidine(DEX)in different doses on circulation fluctuation,anesthesia depth,muscle relaxation and safety during adrenal pheochromocytoma resection.MethodsA total of 78 patients undergoing adrenal pheochromocytoma resection in Shangqiu First people’s Hospital and and the First Affiliated Hospital of Zhengzhou University from Sep.2020 to Sep.2022 were prospectively selected and divided into two groups with 39 cases in each group by random number table method.The 0.2μg group were given 0.2μg·kg^(-1)·h^(-1)DEX 30min before general anesthesia induction,and the 0.4μg group were given 0.4μg·kg^(-1)·h^(-1)DEX 30min before general anesthesia induction until tumor vessels were completely clamped.The time cycle fluctuation(heart rate(HR),mean arterial pressure(MAP),blood oxygen saturation(SpO 2)),anesthesia depth,muscle relaxation effect,anesthesia recovery,vasoactive drug use and safety of the two groups were compared.ResultsAfter induction of anesthesia and the end of surgery,HR in the 0.4μg group was(92.73±9.58)bpm and(84.39±8.65)bpm,both lower than HR in the 0.2μg group of(103.57±6.91)bpm and(91.53±7.27)bpm,respectively.MAP was(85.30±4.29)mmHg and(80.45±6.38)mmHg,both lower than MAP in the 0.2μg group of(96.35±5.88)mmHg and(84.92±5.19)mmHg,respectively.After tumor resection,HR and MAP were(80.22±7.30)bpm and(77.46±7.10)mmHg,both higher than the HR and MAP in the 0.2μg group of(75.14±5.82)bpm and(73.92±6.03)mmHg,respectively(P<0.05).NI immediately after endotracheal intubation in the 0.4μg group was(52.23±5.40),lower than that in the 0.2μg group(58.78±5.92)(P<0.05);The onset time in the 0.4μg group was(91.00±10.00)s,earlier than that in the 0.2μg group(105.00±12.00)s(P<0.05);SAS score at tracheal extubation in the 0.4μg group was 5(4,5),lower than that in the 0.2μg group(4,3,4)(P<0.05);The doses of phentolamine,norepinephrine,and nitroglycerin in the 0.4μg group were(2.64±0.35)mg,(60.42±8.57)μg,and(102.00±12.31)μg/kg·min,respectively

关 键 词：肾上腺嗜铬细胞瘤 右美托咪定 循环波动 镇静-躁动评分 肌松 麻醉深度 复苏时间 

分 类 号：R614[医药卫生—麻醉学] R736.6[医药卫生—外科学]