中外医学研究
中外醫學研究
중외의학연구
CHINESE AND FOREIGN MEDICAL RESEARCH
2014年
26期
5-7
,共3页
鼻内镜手术%炎症因子%右旋美托咪啶%控制性降压
鼻內鏡手術%炎癥因子%右鏇美託咪啶%控製性降壓
비내경수술%염증인자%우선미탁미정%공제성강압
Endoscopic sinus surgery%Inflammatory factor%Dexmedetomidine%Deliberate hypotension
目的：观测右旋美托咪啶用于鼻内镜手术时进行控制性低血压时对炎症因子的影响。方法：选取在全身麻醉下实施鼻内镜术患者80例，ASA分级Ⅰ~Ⅱ级，用随机数字表法将患者分成生理盐水空白组(C组)和右旋美托咪定组(D组)，每组40例。麻醉诱导开始前(T1)30 min， D组静脉持续缓慢输注右旋美托咪定负荷剂量1.0μg/kg，然后持续以0.5μg/kg·h的速率静脉输注维持至手术结束，C组静脉注射等容量生理盐水。分别记录麻醉诱导前30 min(T0)、气管插管时刻(T1)、气管导管拔出时刻(T2)的MAP(平均动脉压)、HR(心率)，抽取T0、T2、术后2 h(T3)、术后6 h(T4)、手术结束后12 h(T5)、手术结束后24 h(T6)的外周静脉血用来检测C反应蛋白(CRP)、白介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)在血液中的浓度。结果：T1、T2时间点为手术过程当中刺激最大的时间点，C组T1、T2时间点较T0时HR、MAP明显升高，比较差异均有统计学意义(P<0.05)。D组T0、T1、T2时间点HR变化不明显，MAP有所升高，比较差异均有统计学意义(P<0.05)。D组T1、T2时间点HR、MAP较C组明显降低，比较差异均有统计学意义(P<0.05)。C组中CRP从T3时间点开始升高，IL-6，TNF-α均从T2时间点开始升高，在T4时点升至最高点，T5时点开始下降，与本组T0时间点比较差异均有统计学意义(P<0.05)。D组CRP从T4时间点开始升高，IL-6、TNF-α均从T3时间点开始升高，在T4时间点升至最高点，T5时点开始下降，与本组T0时间点比较差异均有统计学意义(P<0.05)。D组在T2~6各时间点的CRP、IL-6和TNF-α水平均明显低于C组，两组比较差异均有统计学意义(P<0.05)。结论：右旋美托咪定在鼻内镜手术时用于控制性降压是安全有效的，而且可以降低炎症反应，降低术后感染的几率。
目的：觀測右鏇美託咪啶用于鼻內鏡手術時進行控製性低血壓時對炎癥因子的影響。方法：選取在全身痳醉下實施鼻內鏡術患者80例，ASA分級Ⅰ~Ⅱ級，用隨機數字錶法將患者分成生理鹽水空白組(C組)和右鏇美託咪定組(D組)，每組40例。痳醉誘導開始前(T1)30 min， D組靜脈持續緩慢輸註右鏇美託咪定負荷劑量1.0μg/kg，然後持續以0.5μg/kg·h的速率靜脈輸註維持至手術結束，C組靜脈註射等容量生理鹽水。分彆記錄痳醉誘導前30 min(T0)、氣管插管時刻(T1)、氣管導管拔齣時刻(T2)的MAP(平均動脈壓)、HR(心率)，抽取T0、T2、術後2 h(T3)、術後6 h(T4)、手術結束後12 h(T5)、手術結束後24 h(T6)的外週靜脈血用來檢測C反應蛋白(CRP)、白介素-6(IL-6)和腫瘤壞死因子-α(TNF-α)在血液中的濃度。結果：T1、T2時間點為手術過程噹中刺激最大的時間點，C組T1、T2時間點較T0時HR、MAP明顯升高，比較差異均有統計學意義(P<0.05)。D組T0、T1、T2時間點HR變化不明顯，MAP有所升高，比較差異均有統計學意義(P<0.05)。D組T1、T2時間點HR、MAP較C組明顯降低，比較差異均有統計學意義(P<0.05)。C組中CRP從T3時間點開始升高，IL-6，TNF-α均從T2時間點開始升高，在T4時點升至最高點，T5時點開始下降，與本組T0時間點比較差異均有統計學意義(P<0.05)。D組CRP從T4時間點開始升高，IL-6、TNF-α均從T3時間點開始升高，在T4時間點升至最高點，T5時點開始下降，與本組T0時間點比較差異均有統計學意義(P<0.05)。D組在T2~6各時間點的CRP、IL-6和TNF-α水平均明顯低于C組，兩組比較差異均有統計學意義(P<0.05)。結論：右鏇美託咪定在鼻內鏡手術時用于控製性降壓是安全有效的，而且可以降低炎癥反應，降低術後感染的幾率。
목적：관측우선미탁미정용우비내경수술시진행공제성저혈압시대염증인자적영향。방법：선취재전신마취하실시비내경술환자80례，ASA분급Ⅰ~Ⅱ급，용수궤수자표법장환자분성생리염수공백조(C조)화우선미탁미정조(D조)，매조40례。마취유도개시전(T1)30 min， D조정맥지속완만수주우선미탁미정부하제량1.0μg/kg，연후지속이0.5μg/kg·h적속솔정맥수주유지지수술결속，C조정맥주사등용량생리염수。분별기록마취유도전30 min(T0)、기관삽관시각(T1)、기관도관발출시각(T2)적MAP(평균동맥압)、HR(심솔)，추취T0、T2、술후2 h(T3)、술후6 h(T4)、수술결속후12 h(T5)、수술결속후24 h(T6)적외주정맥혈용래검측C반응단백(CRP)、백개소-6(IL-6)화종류배사인자-α(TNF-α)재혈액중적농도。결과：T1、T2시간점위수술과정당중자격최대적시간점，C조T1、T2시간점교T0시HR、MAP명현승고，비교차이균유통계학의의(P<0.05)。D조T0、T1、T2시간점HR변화불명현，MAP유소승고，비교차이균유통계학의의(P<0.05)。D조T1、T2시간점HR、MAP교C조명현강저，비교차이균유통계학의의(P<0.05)。C조중CRP종T3시간점개시승고，IL-6，TNF-α균종T2시간점개시승고，재T4시점승지최고점，T5시점개시하강，여본조T0시간점비교차이균유통계학의의(P<0.05)。D조CRP종T4시간점개시승고，IL-6、TNF-α균종T3시간점개시승고，재T4시간점승지최고점，T5시점개시하강，여본조T0시간점비교차이균유통계학의의(P<0.05)。D조재T2~6각시간점적CRP、IL-6화TNF-α수평균명현저우C조，량조비교차이균유통계학의의(P<0.05)。결론：우선미탁미정재비내경수술시용우공제성강압시안전유효적，이차가이강저염증반응，강저술후감염적궤솔。
Objective:To investigate the effects of deliberate hypotension of dexmedetomidine on inflammatory factors in patients undergoing endoscopic sinus surgery.Method:Eighty ASA Ⅰor Ⅱpatients scheduled for elective endoscopic sinus surgery were randomly divided into blank group(group C) and dexmedetomidine group(group D),each group of 40 cases.Group D was given continual intravenous injection of dexmedetomidine(1.0μg/kg) at 30 minutes before induction of anesthesia,followed by infusion of dexmedetomidine[0.5μg/(kg·h)] until the end of surgery.Group C was given an equal volume of normal saline. Heart rate(HR),mean arterial pressure(MAP) were determined 30 minutes before anesthesia induction(T0),immediately after induction(T1),immediately after extubation(T2).The cervical venous blood samples were obtained from the patient at 30 minutes before anesthesia induction (T0),when endotracheal tube was removed (T2) and 2 h(T3),6 h(T4),12 h(T5),24 h(T6) post operation for determination of the expression of CPR,IL-6 and TNF-α.Result:The difference of the general situation and the monitoring indicators of intraoperative between the patients of the two groups was not statistically significant(P>0.05).Compared with group C,CPR,IL-6 and TNF-αof group D were all lower at each time point of T2-T6,difference was statistically significant (P<0.05).Compared with T0,CPR of group C was began to rise from T3,IL-6 and TNF-αof group C were began to rise from T2,and rosen to the highest at T4,began to decline at T5;CPR of group D was began to rise from T4,IL-6 and TNF-αof D group were began to rise from T3,and rosen to the highest at T4,began to decline at T5,difference was statistically significant (P<0.05).Conclusion:Deliberate hypotension of dexmedetomidine in patients undergoing endoscopic sinus surgery is safe and feasible and can reduce inflammation and postoperative infection.
