CAJ | 학술논문

目的探讨右美托咪定(dexmedetomidine,Dex)对急性颅脑外伤患者围术期血流动力学和血浆儿茶酚胺(catecholamines,CAs)水平的影响. 方法急性颅脑外伤Ⅲ级患者40例,按随机数字表法分为Dex组(D组)和生理盐水组(C组),每组20例,D组患者在麻醉诱导前10 min静脉推注Dex 0.5 μg/kg,继以0.2 μg· kg-1· h-1～0.7μg· kg-1·h-1静脉泵注,C组患者给予等量的生理盐水.观察记录患者入室(T1)、麻醉诱导前(T2)、气管插管后1 min(T3)、手术1 h(T4)和拔除气管导管后(T5)的平均动脉压(mean arterial pressure,MAP)和心率(heart rate,HR),同时检测这5个时间点患者血浆肾上腺素(epinephrine,E)、去甲肾上腺素(norepinephrine,NE)水平. 结果 D组T2、T3、T4和T5时点MAP[(95±9)、(87±9)、(80±8)、(90±9) mmHg(1 mmHg=0.133 kPa)]明显低于T1时点[(112±10) mmHg] (P＜0.05),D组T2、T3、T4和T5时点HR[(92±7)、(75±8)、(65±5)、(85±7)次/min]明显低于T1时点[(110±9)次/min](P＜0.05),D组T2、T3、T4和T5时点E[(93±8)、(78±7)、(75±8)、(87±7)ng/L]明显低于T1时点[(110±10) ng/L](P＜0.05),D组T2、T3、T4和T5时点NE水平[(378±35)、(355±34)、(335±35)、(362±32) ng/L]明显低于T1时点[(420±40) ng/L](P＜0.05),C组T2和T5时点各指标与T1时点比较差异无统计学意义,而T3和T4时点明显低于T1时点(P＜0.05).C组T2、T3、T4和T5时点各指标明显高于D组(P＜0.05). 结论全麻辅助应用Dex能维持患者的血流动力学稳定,并抑制E和NE的释放,明显抑制急性脑外伤患者的应激水平.
목적 탐토우미탁미정(dexmedetomidine,Dex)대급성로뇌외상환자위술기혈류동역학화혈장인다분알(catecholamines,CAs)수평적영향. 방법 급성로뇌외상Ⅲ급환자40례,안수궤수자표법분위Dex조(D조)화생리염수조(C조),매조20례,D조환자재마취유도전10 min정맥추주Dex 0.5 μg/kg,계이0.2 μg· kg-1· h-1～0.7μg· kg-1·h-1정맥빙주,C조환자급여등량적생리염수.관찰기록환자입실(T1)、마취유도전(T2)、기관삽관후1 min(T3)、수술1 h(T4)화발제기관도관후(T5)적평균동맥압(mean arterial pressure,MAP)화심솔(heart rate,HR),동시검측저5개시간점환자혈장신상선소(epinephrine,E)、거갑신상선소(norepinephrine,NE)수평. 결과 D조T2、T3、T4화T5시점MAP[(95±9)、(87±9)、(80±8)、(90±9) mmHg(1 mmHg=0.133 kPa)]명현저우T1시점[(112±10) mmHg] (P＜0.05),D조T2、T3、T4화T5시점HR[(92±7)、(75±8)、(65±5)、(85±7)차/min]명현저우T1시점[(110±9)차/min](P＜0.05),D조T2、T3、T4화T5시점E[(93±8)、(78±7)、(75±8)、(87±7)ng/L]명현저우T1시점[(110±10) ng/L](P＜0.05),D조T2、T3、T4화T5시점NE수평[(378±35)、(355±34)、(335±35)、(362±32) ng/L]명현저우T1시점[(420±40) ng/L](P＜0.05),C조T2화T5시점각지표여T1시점비교차이무통계학의의,이T3화T4시점명현저우T1시점(P＜0.05).C조T2、T3、T4화T5시점각지표명현고우D조(P＜0.05). 결론 전마보조응용Dex능유지환자적혈류동역학은정,병억제E화NE적석방,명현억제급성뇌외상환자적응격수평.
Objective To investigate the effects of dexmedetomidine (Dex) on the perioperative hemodynamics and level of catecholamine (CAs) in acute craniocerebral injury.Methods Forty patients under acute craniocerebral trauma level 3 were randomly divided into the Dex group (group D,n=20) and the control group (group C,n=20).None of the groups received preoperative medication.In group D,the patients received intravenous injection of Dex (0.5 μg/kg) 10 min before anesthesia induction,and then received continuous infusion of Dex at a rate of 0.2 μg· kg-1· h-1-0.7 μg· kg-1· h-1 during the operation,while in group C,the patients were given the same amount of saline.Mean arterial pressure(MAP) and heart rate(HR) were recorded into the operate room (T1),before the induction of anesthesia (T2),1 min after intubation (T3),1 h after incision (T4),and after extubation(T5).Meanwhile,the levels of plasma epinephrine (E) and norepinephrine (NE) were measured at the five time points.Results MAP and HR at T2,T3,T4 and T5[(95±9),(87±9),(80±8),(90±9) mmHg(1 mmHg=0.133 kPa).(92±7),(75±8),(65±5),(85±7) bpm] were significantly lower than those of T1 [(112±10) mmHg,(110±9) bpm] in group D(P＜0.05).Levels of E and NE at T2,T3,T4 and T5 [(93±8),(78±7),(75±8),(87±7) ng/L (378±35),(355±34),(335±35),(362±32) ng/L] were significandy lower than those of T1 [(110±10) ng/L,(420±40) ng/L] in group D (P＜0.05).Compared with those of T1,MAP and HR were not changed significantly at T2 and T5,and significantly decreased at T3 and T4 in group C (P＜0.05).The levels of E and NE at T2,T3,T4 and T5 were significantly lower than those of T1 in group D (P＜0.05).Compared with that of T1,the levels of E and NE were not changed significantly at T2 and T5 and were significantly decreased at T3 and T4 in group D (P＜0.05).Conclusions During acute craniocerebral trauma operation under general anesthesia,Dex could stabilize hemodynamics,decrease the release of E and NE,and inhibit the stress response.