CAJ | 학술논문

目的比较不同剂量右美托咪啶抑制气管插管诱发患者心血管反应的效应.方法拟在全麻下行择期上腹部手术患者120例,年龄18～60岁,体重45～80 kg,ASA分级Ⅰ或Ⅱ级,随机分为4组(n=30):对照组(C组)、低、中、高剂量右美托咪啶组(M1～3组),分别在麻醉诱导前15 min静脉输注15 ml生理盐水、右美托咪啶0.25、0.50和1.00μg/kg,输注时间15 min.麻醉诱导后,BIS值≤60并维持5 s时行气管插管后机械通气.于输注右美托咪啶前(T0)、气管插管前(T1)、气管插管即刻(T2)、气管插管后1、3、5、10 min(T3～6)时记录BP和HR;颈内静脉采血,测定血浆肾上腺素(E)、去甲肾上腺素(NE)浓度.结果与T0时比较,T1时M1～3组HR降低、M3组BP升高,T4～6时C组和M1组血浆E和NE浓度升高(P＜0.05);与T1时比较,C组和M1组T2时BP和HR降低,T3～5时BP和HR升高(P＜0.05);T1～6时M3组较M2组BP升高(P＜0.05).结论静脉输注右美托咪啶剂量达0.5μg/kg时,可显著抑制伤害性刺激诱发的应激反应.
목적 비교불동제량우미탁미정억제기관삽관유발환자심혈관반응적효응.방법 의재전마하행택기상복부수술환자120례,년령18～60세,체중45～80 kg,ASA분급Ⅰ혹Ⅱ급,수궤분위4조(n=30):대조조(C조)、저、중、고제량우미탁미정조(M1～3조),분별재마취유도전15 min정맥수주15 ml생리염수、우미탁미정0.25、0.50화1.00μg/kg,수주시간15 min.마취유도후,BIS치≤60병유지5 s시행기관삽관후궤계통기.우수주우미탁미정전(T0)、기관삽관전(T1)、기관삽관즉각(T2)、기관삽관후1、3、5、10 min(T3～6)시기록BP화HR;경내정맥채혈,측정혈장신상선소(E)、거갑신상선소(NE)농도.결과 여T0시비교,T1시M1～3조HR강저、M3조BP승고,T4～6시C조화M1조혈장E화NE농도승고(P＜0.05);여T1시비교,C조화M1조T2시BP화HR강저,T3～5시BP화HR승고(P＜0.05);T1～6시M3조교M2조BP승고(P＜0.05).결론 정맥수주우미탁미정제량체0.5μg/kg시,가현저억제상해성자격유발적응격반응.
Objective To compare the effects of different doses of dexmedetomidine in inhibition of cardiovascular response to endotracheal intubation. Methods One hundred and twenty ASA Ⅰ or Ⅱ patients, aged 18-60 yr, weighing 45-80 kg, scheduled for upper abdominal surgery, were randomly assigned to one of 4 groups (n = 30 each): control group (group C); low, median and high doses of dexmedetomidine groups (group M1-3) .In group M1-3, 15 min before anesthesia induction, dexmedetomidine 0.25, 0.5 and 1.0 μg/kg were infused over 15 min respectively, while normal saline 15 ml was given instead of dexmedetomidine in group C. After anesthesia induction, tracheal intubation was performed when the BIS value ≤ 60 and it was maintained for 5 s. The patients were mechanically ventilated. BP and HR were recorded before infusion of dexmedetomidine (T0), before intubation (T1), immediately after intubation (T2) and at 1, 3, 5 and 10 min after intubation (T3-6). Venous blood samples were also taken at the same time to measure the plasma concentrations of epinephrine (E) and norepinephrine (NE). Results Compared with T0, HR was significantly decreased at T1 in group M1-3, BP was significantly increased at T1 in group M3, and the plasma concentrations of E and NE were significantly increased at T4-6 in group C and M1(P ＜0.05). BP and HR were significantly lower at T2, while higher at T3-5 in group C and M1than at T1 (P ＜ 0.05). BP at T1-6 was significantly higher in group M3 than in group M2 (P ＜ 0.05). Conclusion When the dose of dexmedetomidine reaches 0.5 μg/kg, it may effectively inhibit the stress reaction to noxious stimulation.