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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2010, Vol. 04 ›› Issue (04) : 341 -344. doi: 10.3877/cma.j.issn.1674-0793.2010.04.012

所属专题： 文献；

论著

右美托咪啶对胃肠手术患者全身麻醉诱导期的影响
荣健1, 黄绍洪1, 牛丽君1, 郭隽英1, 肖亮灿1,†()   
  1. 1. 510080　广州，中山大学附属第一医院麻醉科
  • 收稿日期:2010-03-01 出版日期:2010-08-01
  • 通信作者: 肖亮灿

Effect of dexmedetomidine hydrochloride by target controlled perfusion on period of induction of general anesthesia in patients with abdominal operations

Jian RONG1, Shao-hong HUANG1, Li-jun NIU1, Jun-ying GUO1, Liang-can XIAO1,†()   

  1. 1. Department of Anesthesiology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
  • Received:2010-03-01 Published:2010-08-01
  • Corresponding author: Liang-can XIAO
  • About author:
    Corresponding author: XIAO Liang-can, E-mail:
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荣健, 黄绍洪, 牛丽君, 郭隽英, 肖亮灿. 右美托咪啶对胃肠手术患者全身麻醉诱导期的影响[J]. 中华普通外科学文献(电子版), 2010, 04(04): 341-344.

Jian RONG, Shao-hong HUANG, Li-jun NIU, Jun-ying GUO, Liang-can XIAO. Effect of dexmedetomidine hydrochloride by target controlled perfusion on period of induction of general anesthesia in patients with abdominal operations[J]. Chinese Archives of General Surgery(Electronic Edition), 2010, 04(04): 341-344.

目的

评估全身麻醉前靶控输注右美托咪啶对全身麻醉诱导期的影响。

方法

40例全麻下择期行胃肠手术患者随机分为安慰剂组（PLACEBO）和右美托咪啶组（DEX），各20例。诱导前两组患者分别接受静脉靶控输注右美托咪啶（血浆靶浓度0.6 ng/ml）或等量生理盐水，持续输注15 min；随后靶控输注异丙酚、静脉注射芬太尼和顺式阿曲库铵进行麻醉诱导，观察血流动力学、意识及不良应激反应变化。记录入睡时间及入睡时异丙酚血浆浓度。高效液相色谱法检测诱导前以及气管插管后10 min血浆中肾上腺素（E）和去甲肾上腺素（NE）含量。

结果

DEX组在麻醉诱导期间平均动脉血压表现平稳，与基础值相比，PLACEBO组平均动脉血压在气管插管前以及气管插管后10 min显著降低，P<0.05。DEX组入睡时间较PLACEBO组明显缩短，DEX组入睡时异丙酚血浆浓度较PLACEBO组明显降低，插管时DEX组血浆肾上腺素（E）和去甲肾上腺素（NE）明显降低，P均<0.05。

结论

麻醉诱导期靶控输注右美托咪啶可减少血浆肾上腺素和去甲肾上腺素，稳定血流动力学，同时可减少全身麻醉诱导期异丙酚用量。

关键词: 右美托咪啶, 靶控输注, 应激反应, 血流动力学
Objective

To evaluate the effects of dexmedetomidine hydrochloride by target controlled perfusion on period of induction of general anesthesia.

Methods

Forty patients were admitted for abdominal operation in general anesthesia were randomly assigned into the placebo group (PLACEBO) and dexmedetomidine group (DEX). Two groups received dexmedetomidine hydrochloride by target controlled perfusion ( plasma concentration 0.6 ng/ml) or tales doses of saline for 15 min before induction. Then general anesthesia was inducted by target controlled perfusion of propofol, intravenous injection of fentanyl and cisatracurium. Hemodynamics, consciousness and distress reaction were observed. The time to fall sleep and the plasma concentration of propofol were recorded. Blood epinephrine and norepinephrine before induction and 10 minutes after intubation were detected by high efficiency liquid chromatography.

Results

Hemodynamics in DEX presented more stable during the whole period of induction. Compared with baseline, MAP in PLACEBO group decreased significantly before intubation and 10 min after intubation, P<0.05. Compared with those in PLACEBO group, patients in DEX group falled sleep faster with significant lower dose of propofol, P<0.05. Blood epinephrine and norepinephrine in DEX group were significant lower than that in PLACEBO group when intubation, P<0.05.

Conclusions

Target controlled perfusion of dexmedetomidine hydrochloride with 0.6 ng/ml plasma concentration for 15 minutes before induction decreases blood epinephrine and norepinephrine with more stable hemodynamics. It also reduces the dosis of propofol in the period of induction.

Key words: Dexmedetomidine hydrochloride, Target controlled perfusion, Stress reaction, Hemodynamics
表1 两组患者一般资料(±s)
项目 PLACEBO DEX
年龄(y) 51.5±7.3 49.2±8.4
性别(M/F) 11/9 10/10
体重(kg) 53.2±13.6 55.1±11.3
基础平均动脉血压(mmHg) 54.6±5.2 56.7±3.1
基础心率(bpm) 73±15 69±11
基础中心静脉压(mmHg) 6±0.7 5±0.9
图1 两组患者诱导期前后血流动力学比较
图2 两组血浆肾上腺素和去甲肾上腺素比较（ng/L）
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