妇科腹腔镜手术患者术前鼻内滴注右美托咪定对全身麻醉气管插管应激反应的影响
부과복강경수술환자술전비내적주우미탁미정대전신마취기관삽관응격반응적영향
Effects of intranasal dexmedetomidine premedication on stress of tracheal intubation in patients undergoing gynecological laparoscopic surgery
  • 万方数据
    中国医药 중국의약
    CHINA MEDICINE
    2015年 1期 110-114 ,共5页

    曾庆玲%官英勇%黄今肇%马媛

    증경령%관영용%황금조%마원

    腹腔镜手术%右美托咪定%气管插管%应激反应 腹腔鏡手術%右美託咪定%氣管插管%應激反應
    복강경수술%우미탁미정%기관삽관%응격반응
    Laparoscopic surgery%Dexmedetomidine%Tracheal intubation%Stress
    目的 探讨妇科腹腔镜手术患者术前鼻内滴注右美托咪定对全身麻醉气管插管应激反应的影响.方法 选取行妇科腹腔镜手术患者65例,将患者按随机数字表随机分为右美托咪定1.0 μg/kg组(22例)、右美托咪定2.0 μg/kg组(23例)和对照组(20例).全身麻醉诱导前30 min分别给右美托咪定1.0μg/kg组和右美托咪定2.0 μg/kg组按右美托咪定1.0μg/kg和2.0tμg/kg鼻内滴注给药,而对照组给予等量的0.9％氯化钠注射液.记录3组患者鼻内给药前(R)、麻醉诱导前(T1)、插管前(T2)、插管后1 min(T3)、插管后3 min(T4)、插管后6min(T5)各时点的心率和血压;于T0、T1和T4时点检测3组患者血清去甲肾上腺素(NE)、肾上腺素、皮质醇和血糖水平.结果 T1、T3、T4和T54个时点右美托咪定1.0 μg/kg组和右美托咪定2.0 μg/kg组心率和收缩压明显低于对照组[T1:(79±9)、(72±8)次/min比(88±11)次/min,(114±12)、(111±14)mmHg(1 mmHg =0.133 kPa)比(123±12) mmHg,T3:(85 ±13)、(82±11)次/min比(99±15)次/min,(124±13)、(115±11)mmHg比(133±14) mmHg,T4:(89± 12)、(81±11)次/min比(102±14)次/min,(125±12)、(116±10) mmHg比(136±15) mmHg,T5:(84±11)、(77±10)次/min比(94±13) 次/min,(118±12)、(110±10) mmHg比(130±12)mmHg](均P＜0.05),右美托咪定2.0 μg/kg组患者的心率和收缩压在T1、T3、T4和T54个时点也明显低于右美托咪定1.0 μg/kg组(P＜0.05);T1和T4时点右美托咪定1.0 μg/kg组和右美托咪定2.0 μg/kg组患者的NE、肾上腺素、皮质醇和血糖明显低于对照组[T1:(164±15)、(135±13) ng/L比(195±15) ng/L,(28.7 ±2.5)、(25.4±2.8) ng/L比(35.8±3.9) ng/L,(205 ±37)、(198±32) ng/L比(235±36) ng/L,(4.4±0.4)、(4.3 ±0.4) mmol/L比(4.7 ±0.5) mmol/L;T4:(195±17)、(184±16) ng/L比(234±16) ng/L,(34.6±3.5)、(30.5 ±3.1)ng/L比(41.5 ±4.5)ng/L,(254 ±42)、(240±40) ng/L比(286±46) ng/L,(4.8±0.4)、(4.5±0.4) mmol/L比(5.3 ±0.6) mmol/L](均P＜0.05),且T1和T4时点右美托咪定2.0 μg/kg组患者的NE、肾上腺素,皮质醇和血糖明显低于有美托咪定1.0 μg/kg组(P＜0.05).结论 妇科腹腔镜手术患者术前鼻内滴注右美托咪定1.0～2.0 μg/kg能够有效抑制全身麻醉气管插管的应激反应.
    목적 탐토부과복강경수술환자술전비내적주우미탁미정대전신마취기관삽관응격반응적영향.방법 선취행부과복강경수술환자65례,장환자안수궤수자표수궤분위우미탁미정1.0 μg/kg조(22례)、우미탁미정2.0 μg/kg조(23례)화대조조(20례).전신마취유도전30 min분별급우미탁미정1.0μg/kg조화우미탁미정2.0 μg/kg조안우미탁미정1.0μg/kg화2.0tμg/kg비내적주급약,이대조조급여등량적0.9％록화납주사액.기록3조환자비내급약전(R)、마취유도전(T1)、삽관전(T2)、삽관후1 min(T3)、삽관후3 min(T4)、삽관후6min(T5)각시점적심솔화혈압;우T0、T1화T4시점검측3조환자혈청거갑신상선소(NE)、신상선소、피질순화혈당수평.결과 T1、T3、T4화T54개시점우미탁미정1.0 μg/kg조화우미탁미정2.0 μg/kg조심솔화수축압명현저우대조조[T1:(79±9)、(72±8)차/min비(88±11)차/min,(114±12)、(111±14)mmHg(1 mmHg =0.133 kPa)비(123±12) mmHg,T3:(85 ±13)、(82±11)차/min비(99±15)차/min,(124±13)、(115±11)mmHg비(133±14) mmHg,T4:(89± 12)、(81±11)차/min비(102±14)차/min,(125±12)、(116±10) mmHg비(136±15) mmHg,T5:(84±11)、(77±10)차/min비(94±13) 차/min,(118±12)、(110±10) mmHg비(130±12)mmHg](균P＜0.05),우미탁미정2.0 μg/kg조환자적심솔화수축압재T1、T3、T4화T54개시점야명현저우우미탁미정1.0 μg/kg조(P＜0.05);T1화T4시점우미탁미정1.0 μg/kg조화우미탁미정2.0 μg/kg조환자적NE、신상선소、피질순화혈당명현저우대조조[T1:(164±15)、(135±13) ng/L비(195±15) ng/L,(28.7 ±2.5)、(25.4±2.8) ng/L비(35.8±3.9) ng/L,(205 ±37)、(198±32) ng/L비(235±36) ng/L,(4.4±0.4)、(4.3 ±0.4) mmol/L비(4.7 ±0.5) mmol/L;T4:(195±17)、(184±16) ng/L비(234±16) ng/L,(34.6±3.5)、(30.5 ±3.1)ng/L비(41.5 ±4.5)ng/L,(254 ±42)、(240±40) ng/L비(286±46) ng/L,(4.8±0.4)、(4.5±0.4) mmol/L비(5.3 ±0.6) mmol/L](균P＜0.05),차T1화T4시점우미탁미정2.0 μg/kg조환자적NE、신상선소,피질순화혈당명현저우유미탁미정1.0 μg/kg조(P＜0.05).결론 부과복강경수술환자술전비내적주우미탁미정1.0～2.0 μg/kg능구유효억제전신마취기관삽관적응격반응.
    Objective To investigate the effects of intranasal dexmedetomidine premedication on stress of tracheal intubation in patients undergoing gynecological laparoscopic surgery.Methods The study enrolled 65 patients who underwent selective gynecological laparoscopic surgery.All patients were randomly assigned to three groups:dexmedetomidine 1.0 pμg/kg group (intranasal administrated dexmedetomidine 1.0 μg/kg 30 min before induction of anesthesia,n =22) ; dexmedetomidine 2.0 μg/kg group (intranasal administrated dexmedetomidine 2.0 μg/kg,n =23) ; control group (placebo,intranasal administrated normal saline l ml,n =20).Systolic blood pressure (SBP),diastolic blood pressure (DBP) and heart rate (HR) were recorded at 5 min before the intranasal administered drug (T0),before induction (T1),before trachea cannula after induction (T2),l minute (T3),3 minutes(T4) and 6 minutes (T5) after trachea cannula during anesthetic induction.The levels of NE (norepinephrine),epinephrine,cortisol and the blood sugar concentration were measured at the time of T0,T1 and T4.Results At the time of T1,T3,T4,T5,the HR values and SBP in both dexmedetomidine 1.0 μg/kg group and dexmedetomidine 2.0 μg/kg group were significantly lower than that in the control group [T1:(79 ± 9),(72 ± 8) times/min vs (88 ± 11) times/min,(114 ± 12),(111 ± 14) mmHg vs (123 ± 12) mmHg; T3:(85 ± 13),(82 ± 11) times/min vs (99 ± 15) times/min,(124 ± 13),(115 ± 11) mmHg vs (133 ± 14) mmHg; T4:(89 ± 12),(81 ± 11) times/min vs (102 ± 14) times/min,(125 ± 12),(116 ± 10) mmHg vs (136 ± 15) mmHg,T5:(84 ± 11),(77 ± 10) times/min vs (94 ± 13) times/min,(118 ± 12),(110 ± 10) mmHg vs (130 ± 12) mmHg],while the HR and SBP values in dexmedetomidine 2.0 μg/kg group remarkable better than dexmedetomidine 1.0 μg/kg group (P ＜ 0.05) ; while those values in dexmedetomidine 2.0 μg/kg group were significanty lower than in dexmedetomidine 1.0 μg/kg group (P ＜ 0.05).The concentration of NE,epinephrine,cortisol and the blood sugar at T1,T4 in dexmedetomidine 1.0 μg/kg group and dexmedetomidine 2.0 μg/kg group was significanty lower than in the control group[T1:(164 ± 15),(135 ± 13) ng/L vs (195 ± 15) ng/L,(28.7 ± 2.5),(25.4 ± 2.8) ng/L vs (35.8 ± 3.9) ng/L,(205 ± 37),(198 ± 32) ng/L vs (235 ± 36) ng/L,(4.4 ± 0.4),(4.3 ± 0.4) mmol/L vs (4.7 ±0.5)mmol/L;T4:(195 ± 17),(184 ± 16) ng/L vs (234 ± 16)ng/L,(34.6 ±3.5),(30.5 ±3.1) ng/L vs (41.5 ± 4.5) ng/L,(254 ± 42),(240 ± 40) ng/L vs (286 ± 46) ng/L,(4.8 ± 0.4),.(4.5 ± 0.4) mmol/L vs (5.3 ± 0.6) mmol/L],while the concentration of NE,epinephrine,cortisol and the blood sugar in dexmedetomidine 2.0 μg/kg group were significantly better than those in dexmedetomidine 1.0 μg/kg group (P ＜ 0.05).Conclusion Intranasal administration of dexmedetomidine of 1.0-2.0 μg/kg at 30 min before operation can effectively reduce stress response to tracheal intubation.
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