【摘要】 目的评价右旋美托咪啶对丙泊酚-舒芬太尼复合诱导双腔气管插管时血流动力学指标影响。方法选择择期开胸手术病人60例,ASAⅠ～Ⅱ级,年龄为40～64岁,随机分为对照组(C组)和右旋美托咪啶组(D组),每组各30例。麻醉诱导前15min,D组静脉泵注右旋美托咪啶0.5μg/kg(生理盐水稀释至10mL),泵注时间10min;C组以相同方式泵注生理盐水10mL。右旋美托咪啶输注完成后以效应室浓度0.4μg/L靶控输注(TCI)舒芬太尼,3min后以血浆靶浓度为3mg/LTCI丙泊酚,意识消失后静注罗库溴胺0.8mg/kg行双腔气管插管。记录两组病人麻醉诱导前基础值(T0)、右旋美托咪啶或生理盐水输注完成后(T1)、插管前即刻(T2)、支气管插管后即刻(T3)和插管后1min(T4)、3min(T5)、5min(T6)的收缩压(SBP)、舒张压(DBP)、心率(HR)。结果与T0比较,T1时D组的HR明显降低(t=2.39,P<0.05),C组HR无明显变化。应用麻醉诱导药物后,两组的SBP和DBP在T2均下降(F=6.16～9.45,P<0.05),但D组的下降幅度明显小于C组(t=3.14、2.78,P<0.05);T3及T4时间点,两组的SBP、DBP和HR较T2均有不同程度升高(F=5.18～14.96,P<0.05),D组的升高幅度明显小于C组(t=2.09～5.44,P<0.05);T5和T6时间点,D组SBP和HR较C组明显降低(t=2.18～3.43,P<0.05),恢复至插管前的水平。结论麻醉诱导前静脉泵注右旋美托咪啶0.5μg/kg,可以有效抑制双腔气管插管引起的应激反应,维持血流动力学指标的平稳。更多还原

【Abstract】 Objective To assess the effects of dexmedetomidine on hemodynamics during double-lumen endotracheal intubation induced by propofol combined with sufentanil. Methods Sixty ASA ⅠorⅡpatients,aged 40-64years,scheduled for thoracic surgery were evenly randomized to control group(group C)and dexmedetomidine group(group D).Patients in group C were given venous pump infusion of dexmedetomidine 0.5μg/kg for 10min(diluted in normal saline to 10mL)15min before anesthesia induction,those in group C were given normal saline the same method as did in group D.After dexmedetomidine was infused, sufentanil was administered by TCI at target effect site concentration of 0.4μg/L.Propofol was then administered by TCI at plasma concentration of 3mg/L 3min after sufentainl was infused.When the patients lost conciousness,rocuronium 0.8mg/kg was administrated and double-lumen endotracheal tube intubated.BP and HR were recorded before infusion of dexmedetomidine(T0),after infusion of dexmedetomidine(T1),before endotracheal intubation(T2),immediately after intubation(T3)and at 1,3,and 5min after intubation(T4,T5,T6). Results Compared with T0,HR significantly decreased in group D at T1(t=2.39,P<0.05), while HR in group C was not obviously changed.After anesthesia induction,the SBP and DBP in both groups decreased at T2(F= 6.16-9.45,P<0.05),but the descent range in group D was much less than that in group C (t=3.14,2.78;P<0.05);SBP and HR somewhat increased at T3and T4in both groups as compared with T2(F=5.18-14.96,P<0.05),but the increase in group D was less than that in group C(t=2.09-5.44,P<0.05);At T5and T6,SBP and HR in group D was significantly less than that in group C(t=2.18-3.43,P<0.05),and returned to before-intubation level. Conclusion Intravenous infusion of dexmedetomidine 0.5μg/kg before anesthesia induction can effectively inhibit stress response caused by double-lumen intubation and maintain stable hemodynamics.更多还原