麻醉%胆囊切除术,腹腔镜%应激
痳醉%膽囊切除術,腹腔鏡%應激
마취%담낭절제술,복강경%응격
Anesthesia%Cholecystectomy,laparoscopic%Stress
目的 探讨右美托咪定对腹腔镜胆囊切除术患者应激反应及肝肾功能的影响. 方法选取100例行腹腔镜下胆囊切除术的患者,根据麻醉方法分为丙泊酚组(50例)和右美托咪定组(50例),观察手术麻醉诱导血流动力学变化及应激反应,同时记录麻醉前、麻醉后及术后肝肾功能变化. 结果 插管即刻及插管后1 min丙泊酚组与有美托咪定组心率[(85.7±13.4)次/min比(62.7±9.9)次/min,t=2.296,P=0.045; (81.3±14.9)次/min比(60.3±8.8)次/min,t=2.714,P=0.022],平均动脉压[(86.3±11.9)mm Hg 比(66.5±11.7) mm Hg,t=2.653,P=0.024;(88.6±15.6) mm Hg比(68.7±12.3)mm Hg,t=2.240,P=0.049]显著升高.插管即刻、插管后1min及5 min丙泊酚组与右美托咪定组患者肾上腺素[(680.1±112.3) pmol/L比(576.1±83.1)pmol/L,t=2.628,P=0.019;(705.4±127.6) pmol/L比(648.8±105.3) pmol/L,t=2.242,P=0.039；(689.6±123.4) pmol/L比(628.2±94.3)pmol/L,t=2.224,P=0.040]、去甲肾上腺素[(3953.6±514.6) pmol/L比(3695.1±496.2) pmol/L,t=2.454,P=0.032;(4367.1±565.7) pmol/L比(3967.2±514.9)pmol/L,t=2.500,P=0.030;(4095.8±415.1) pmol/L比(3813.4±513.7) pmol/L,t=2.255,P=0.045]、皮质醇[(796.6±198.7)nmol/L比(698.7±176.3) nmol/L,t=2.334,P=0.033; (835.5±217.2) nmol/L比(783.7±201.9) nmol/L,t=2.167,P=0.044; (822.4±203.3) nmol/L比(720.6±188.1) nmol/L,t=2.189,P=0.043]比较,右美托咪定组均低于丙泊酚对照组.与麻醉前比较,两组患者肝肾功能比较差异无统计学意义(均P＞0.05). 结论 右美托咪定对腹腔镜胆囊切除术患者血流动力学更稳定,应激反应较轻,对肝肾功能无明显影响,可安全、有效地用于腹腔镜胆囊切除术.
目的 探討右美託咪定對腹腔鏡膽囊切除術患者應激反應及肝腎功能的影響. 方法選取100例行腹腔鏡下膽囊切除術的患者,根據痳醉方法分為丙泊酚組(50例)和右美託咪定組(50例),觀察手術痳醉誘導血流動力學變化及應激反應,同時記錄痳醉前、痳醉後及術後肝腎功能變化. 結果 插管即刻及插管後1 min丙泊酚組與有美託咪定組心率[(85.7±13.4)次/min比(62.7±9.9)次/min,t=2.296,P=0.045; (81.3±14.9)次/min比(60.3±8.8)次/min,t=2.714,P=0.022],平均動脈壓[(86.3±11.9)mm Hg 比(66.5±11.7) mm Hg,t=2.653,P=0.024;(88.6±15.6) mm Hg比(68.7±12.3)mm Hg,t=2.240,P=0.049]顯著升高.插管即刻、插管後1min及5 min丙泊酚組與右美託咪定組患者腎上腺素[(680.1±112.3) pmol/L比(576.1±83.1)pmol/L,t=2.628,P=0.019;(705.4±127.6) pmol/L比(648.8±105.3) pmol/L,t=2.242,P=0.039；(689.6±123.4) pmol/L比(628.2±94.3)pmol/L,t=2.224,P=0.040]、去甲腎上腺素[(3953.6±514.6) pmol/L比(3695.1±496.2) pmol/L,t=2.454,P=0.032;(4367.1±565.7) pmol/L比(3967.2±514.9)pmol/L,t=2.500,P=0.030;(4095.8±415.1) pmol/L比(3813.4±513.7) pmol/L,t=2.255,P=0.045]、皮質醇[(796.6±198.7)nmol/L比(698.7±176.3) nmol/L,t=2.334,P=0.033; (835.5±217.2) nmol/L比(783.7±201.9) nmol/L,t=2.167,P=0.044; (822.4±203.3) nmol/L比(720.6±188.1) nmol/L,t=2.189,P=0.043]比較,右美託咪定組均低于丙泊酚對照組.與痳醉前比較,兩組患者肝腎功能比較差異無統計學意義(均P＞0.05). 結論 右美託咪定對腹腔鏡膽囊切除術患者血流動力學更穩定,應激反應較輕,對肝腎功能無明顯影響,可安全、有效地用于腹腔鏡膽囊切除術.
목적 탐토우미탁미정대복강경담낭절제술환자응격반응급간신공능적영향. 방법선취100례행복강경하담낭절제술적환자,근거마취방법분위병박분조(50례)화우미탁미정조(50례),관찰수술마취유도혈류동역학변화급응격반응,동시기록마취전、마취후급술후간신공능변화. 결과 삽관즉각급삽관후1 min병박분조여유미탁미정조심솔[(85.7±13.4)차/min비(62.7±9.9)차/min,t=2.296,P=0.045; (81.3±14.9)차/min비(60.3±8.8)차/min,t=2.714,P=0.022],평균동맥압[(86.3±11.9)mm Hg 비(66.5±11.7) mm Hg,t=2.653,P=0.024;(88.6±15.6) mm Hg비(68.7±12.3)mm Hg,t=2.240,P=0.049]현저승고.삽관즉각、삽관후1min급5 min병박분조여우미탁미정조환자신상선소[(680.1±112.3) pmol/L비(576.1±83.1)pmol/L,t=2.628,P=0.019;(705.4±127.6) pmol/L비(648.8±105.3) pmol/L,t=2.242,P=0.039；(689.6±123.4) pmol/L비(628.2±94.3)pmol/L,t=2.224,P=0.040]、거갑신상선소[(3953.6±514.6) pmol/L비(3695.1±496.2) pmol/L,t=2.454,P=0.032;(4367.1±565.7) pmol/L비(3967.2±514.9)pmol/L,t=2.500,P=0.030;(4095.8±415.1) pmol/L비(3813.4±513.7) pmol/L,t=2.255,P=0.045]、피질순[(796.6±198.7)nmol/L비(698.7±176.3) nmol/L,t=2.334,P=0.033; (835.5±217.2) nmol/L비(783.7±201.9) nmol/L,t=2.167,P=0.044; (822.4±203.3) nmol/L비(720.6±188.1) nmol/L,t=2.189,P=0.043]비교,우미탁미정조균저우병박분대조조.여마취전비교,량조환자간신공능비교차이무통계학의의(균P＞0.05). 결론 우미탁미정대복강경담낭절제술환자혈류동역학경은정,응격반응교경,대간신공능무명현영향,가안전、유효지용우복강경담낭절제술.
Objective To explore the influences of Dexmedetomidine for laparoscopic cholecystectomy on stress reaction and hepatic/renal functions. Methods Totally 100 cases with laparoscopic cholecystectomy were divided into two groups:Dexmedetormidine group and Propofol control group (n=50 for each group) according to the different anesthetic methods.The hemodynamic change,stress reaction and hepatic/renal function were measured and analyzed. Results Heart rate [(85.7±13.4)times /min vs.(62.7±9.9) times/min; (81.3±14.9) times/min vs.(60.3±8.8)times/min,t=2.296,2.714,P=0.045,0.022] and mean artery pressure(MAP )[(86.3±11.9)mm Hg vs.(66.5+11.7) mm Hg; (88.6±15.6) mm Hg vs.(68.7± 12.3) mm Hg,t=2.653,2.240,P=0.024,0.049] immediately at trachea cannula and 1 min after trachea cannula were significantly increased in Propofol control group as compared with Dexmedetomidine group.In contrast to Propofol control group,epinephrine[(680.1±112.3) pmol/L vs.(576.1±83.1)pmol/L; (705.4±127.6)pmol/L vs.648.8±105.3) pmol/L,(689.6±123.4) pmol/L vs.(628.2±94.3) pmol/L,t=2.628,2.242,2.224,P=0.019,0.039,0.040],norepinephrine[(3953.6±514.6) pmol/L vs.(3695.1±196.2) pmol/L; (3967.2=514.9) pmol/L vs.(4367.1±565.7) pmol/L; (4095.8±415.1) pmol/L vs.(3813.4 ± 513.7) pmol/L, t =2.454, 2.500, 2.255, P =0.032, 0.030,0.045] and hydrocortisone [(796.6±198.7) nmol/L vs.(698.7±176.3) nmol/L; (835.5+217.2) nmol/L vs.(783.7±201.9) nmol/L; (822.4±203.3) nmol/L vs.(720.6±188.1) nmol/L,t=2.334,2.167,2.189,P=0.033,0.044,0.043] immediately at trachea cannula,1 min and 5 min after trachea cannula were decreased in Dexmedetomidine group.There were not significantly differences in hepatic/renal function between the two groups (P＞ 0.05). Conclusions Dexmedetomidine is safe and effective for laparoscopic cholecystectomy in view of more stable hemodynamics,less stress reaction,and non influence on hepatic/renal function.
