切换至 "中华医学电子期刊资源库"
高级检索
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:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

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/OL]. 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/OL]. 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）
1
Khan ZP, Ferguson CN, Jones RM. Alpha-2 and imidazoline receptor agonists. Their pharmacology and therapeutic role. Anesthesia，1999，54(2):146-165.
2
Berkenbosch JW, Wankum PC, Tobias JD. Prospective evaluation of dexmedetomidine for noninvasive procedural sedation in children. Pediatr Crit Care Med，2005，6(4):435-439.
3
Martin E, Ramsay G, Mantz J，et al. The role of the alpha2-adrenoceptor agonist dexmedetomidine in postsurgical sedation in the intensive care unit. J Intensive Care Med，2003，18(1):29-41.
4
Scheinin B, Lindgren L, Randell T，et al. Dexmedetomidine attenuates sympathoadrenal responses to tracheal intubation and reduces the need for thiopentone and peroperative fentanyl. Br J Anaesth，1992，68(2):126-131.
5
Yildiz M, Tavlan A, Tuncer S，et al. Effect of dexmedetomidine on haemodynamic responses to laryngoscopy and intubation: perioperative haemodynamics and anaesthetic requirements. Drugs R D，2006，7(1):43-52.
6
Peden CJ, Cloote AH, Stratford N，et al. The effect of intravenous dexmedetomidine premedicati on the dose requirement of propofol to induce loss of consciousness in patients receiving alfentanil. Anaesthesia，2001，56(5):408-413.
7
Fragen RJ, Fitzgerald PC. Effect of dexmedetomidine on the minimum alveolar concentration (MAC) of sevoflurane in adults age 55 to 70 years. J Clin Anesth，1999，11(6):466-470.
8
徐道妙.围麻醉期应激反应及其调控.国外医学：麻醉学与复苏分册，1995，16(4):207.
9
Bloor BC, Finander LS, Flacke WE，et al. Effect of clonidine on sympathoadrenal response during sodium nitroprusside hypotension. Anesth Analg，1986，65(5):469-474.
[1] 赵梓竣, 兰运升. 改良一针法末端回肠造口术对低位直肠癌保肛术后应激反应及安全性的影响[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 611-614.
[2] 张翼翔, 马明, 田金龙, 杨珊珊, 尚程程, 张景欣. 腹腔镜肝叶切除联合胆道镜取石治疗肝内胆管结石的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 381-384.
[3] 刘晓菊, 姚芮, 杜镇鸿, 李文忠. 经胸壁入路与低位小切口在甲状腺良性肿瘤切除术中的疗效比较研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(02): 204-207.
[4] 丁佳宝, 梁晓辉, 武敬维, 张福. 腹腔镜疝囊高位结扎术在腹股沟嵌顿斜疝患者中的应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 543-547.
[5] 丁荷蓓, 王珣, 陈为国. 七氟烷吸入麻醉与异丙酚静脉麻醉在儿童腹股沟斜疝手术中的应用比较[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 570-574.
[6] 李先锋, 何懿, 程贞永, 邓国魁, 胡波, 谢红, 王莉, 王小燕, 李晓明. 右美托咪定对腹腔镜腹股沟疝修补术患者血流动力学及麻醉复苏效果的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(04): 437-441.
[7] 彭敏敏, 杨晓斌, 芮亚楠. 羟考酮复合舒芬太尼在腹腔镜疝修补术中的应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(02): 218-222.
[8] 郭建丽, 珠娜, 宋飞, 柴国东. 七氟烷吸入复合瑞芬太尼麻醉在小儿腹腔镜疝修补术中的效果[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(02): 223-227.
[9] 任甜甜, 张玉慧, 祁玲霞, 朱梅冬, 胡佳. 多学科疼痛管理对胸腔镜肺叶切除术后胸痛及应激反应的影响分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 630-633.
[10] 潘忠军, 戎国祥, 丁明, 殷优宏, 张双龙. 非气管插管麻醉下单孔胸腔镜手术对肺结节及血流动力学、炎性指标的影响[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(02): 272-275.
[11] 王守森, 傅世龙, 鲜亮, 林珑. 深入理解控制性减压技术对创伤性颅脑损伤术中脑膨出的预防机制与效果[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(05): 257-262.
[12] 陈雪飞, 卜雄建, 张春良. 神经内镜下经鼻蝶窦扩大鞍底入路颅咽管瘤切除术的疗效分析[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(03): 160-165.
[13] 谢浩文, 丁建英, 刘小霞, 冯毅, 姚婧. 椎旁神经阻滞对微创胃切除肥胖患者术中血流、术后应激及康复质量的影响[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 569-573.
[14] 刘聪辉, 何浩然, 黄一诺, 张凤, 王凡月, 郝翰. 膳食铜补充对大鼠心肌梗死后心肌基质金属蛋白酶2表达水平及血流动力学的影响[J/OL]. 中华诊断学电子杂志, 2024, 12(03): 166-172.
[15] 芦乙滨, 李梦蝶, 许明. PDCA（计划、执行、检查和处理）循环教学在内科住院医师重症超声指导血流动力学评估培训中的效果评价[J/OL]. 中华卫生应急电子杂志, 2024, 10(04): 224-228.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号