右美托咪陡预防全麻气管插管和拔管心血管反应的临床观察.pdf

岭南现代临床外科2012年2月第12卷第1期LingnanModernClinicsinSurgery,Feb.2012,Vol.12No.1临床研究基金项目广东省自然科学基金作者单位510120广东广州中山大学孙逸仙纪念医院麻醉科,重症医学科通讯作者李玉娟,Emailyujuan_04yahoo.com.cn右美托咪陡预防全麻气管插管和拔管心血管反应的临床观察张蓉1李玉娟陈亮2摘要目的观察右美托咪陡预防全身麻醉气管插管和拔管过程中心血管反应的临床效果D方法选择30例拟在全身麻醉下行择期腹部手术的患者,随机分G802G81G82G83G81和右美托咪陡G81,G84G8115例DDG81全麻G85G86G87G88G89G8AG8B右美托咪陡1ug/kg,15minG8CG8BG8DCG81G8EG88G89G8CG8BG8FG90的G91G92G93G94DG95G81G85G86G96G97G98G80G99G9AG9B1.5mg/kg,G9CG9DG9E3lg/kgG9FGA0GA1GA2GA3GA4GA50.2mg/kgDGA6GA7GA8GA9GAA下GABGACGADGAEGAFG95G81患者的GB0G98GB1G89GB2心GB3心GB3GB4GB5GB2GB6GB7的GB8GB9①G8BG97G87,DEXGBCG91G92G93G94GBDG8BGBE51015min②插管G871min,插管GBFGC0,插管GBE135min③GC1管G875min,拔管GBFGC0,拔管GBE3510minDGA6GA7G95G81插管和拔管期GAERPP12000的GC2G91GC3GC4D结果DG81G8BG97GBE1015插管G871min的HRGAA基GBAGBB下GC5DDG81插管GBFGC0插管GBE1min拔管GAD的MAP和HRG98GC6GC7GC8GC9CG81DG8BG97GBE15minGCA拔管GBEGACGADGAEGAFDG81患者的RPPG98GC8GC9CG81DDG81在插管和拔管期GAERPP12000的GC2G91GB3GC6GC7GCBGC9CG81DG95G81患者的GCCGCDGADGAE拔管GADGAE和RamsayGCE分GA9GAAGCFGD0GD1GD2GD3学GD4GD5D结论右美托咪陡GD6GC7GD7GD8GD9气管插管和拔管GAD的心血管反应,GDAGDB血GDCGB1GDD学的GDEGDF,GE0GADG82麻醉GE1GE2期GE3GE4GE5GE6D关键词右美托咪陡气管插管气管GC1管心血管反应中日分类号R614.2文献标识码A文童编号1009976X01005605doi10.3969/j.issn.1009976X.2012.01.022ClinicalobservationofdexmedetomidineinpreventionfromcardiovascularresponsetotrachealintubationandextubationduringgeneralanesthesiaZhcngRong1,LiYujucn,ChenLicng2.1.DepcrtmentofAnesthesiology,2DepcrtmentofCriticclCcreMecicine,TheSunYctsenMemoriclHospitcl,SunYctsenUnizersity,Gucngzhou,510120CorresponcingcuthorLiYujucn,Emcilyujucn_04ychoo.com.cnAbstractIObjectiveToevaluatetheeffectofdexmedetomidineinpreventingcardiovascularresponseinducedbytrachealintubationandextubationduringgeneralanesthesia.MethodsAtotalof30patientsunderwentselectiveabdominaloperationundergeneralanesthesiawererandomlydividedintotwogroupscontrolgroupanddexmedetomidinegroup.ThepatientsingroupDreceiveddexmedetomidine1ug/kgintravenousinjectionover15minwhilethoseingroupCreceivedegualvolumeofnormalsalinebeforeanesthesiainduction.Anesthesiawasinducedwithpropofol1.5mg/kg,fentanyl3lg/kgandcisatracurium0.2mg/kginbothgroups.Meanarterialbloodpressure,heartrateandtheratepressureproductwererecordedatthesemoment①beforeinfusion,5min,10minand15minafterinfusion②1minbeforeintubation,themomentofintubation,1min,3minand5minafterintubation③5minbeforeextubation,themomentofextubation,and3min,5minand10minafterextubation.TheincidencesofRPPmorethan12000werecaculatedduringintubationandextubation.ResultsAt10,15minafterinfusionand1minbeforeintubation,HRsignificantlydecreasedingroupD,comparedwiththebaselinevalue.Atthemomentofintubation,1minafterintubation,andthemomentofextubation,MAPandHRsignificantlydecreasedingroupD,comparedwithgroupC.Ateachtimepointfrom15minafterinfusiontoafterextubation,RPPsignificantlydecreasedingroupD,comparedwithgroupC.TheincidencesofRPPmore56CMYK万方数据岭南现代临床外科2012年2月第12卷第1期LingnanModernClinicsinSurgeryFeb.2012Vol.12No.1表1患者一般资料比较i15JIS性别22000与G86GDFGE5G83G85G89GDCGE63D注药后15minGE7拔管后各时间点D组患者的RPP均低GE8C组,D组在插管和拔管期间RPP12000的发生率GD2GE9低GE8C组,GE4示GD5GD6GD7GD8GD9G9AGD1GD258CMYK万方数据岭南现代临床外科2012年2月第12卷第1期LingnanModernClinicsinSurgeryyFeb.2012yVol.12No.1降低心肌耗氧量y此可能与其同时降低血压和心率有关D同时y右美托咪陡对患者苏醒时间和拔管时间没有显著的延长y没明显增加Ramsay镇静评分y对麻醉恢复期无明显影响D右美托咪陡是一种新型高选择性2肾k腺素受体激动剂y2009年6月该药在我国k市D右美托咪陡通过激动中枢神G80G81G822受体G83G84G85的G86G87G88G89G8AG8ByG8CG8DG8EG8FG90G91G92G93动G94G95G96G97G98yG99G9A镇静G9BG96G9CG9DDG9E种镇静G97G98是可G9FGA0GA1激GA2GA3GA4GA5醒的yGA6在G99G9A镇静的过GA7中y无GA8GA9GAAGAByG9E可能GACGADGAEGAFGB0GB1中右美GB2对麻醉恢复期无明显影响的GB3GB4DGB5GAE镇静G9CG9D外y右美托咪陡可通过G9CG9DGB6GB7GB8GB9GBAGBBGBCGBD和中间神G80GBEGBBGBCGB9GBF2受体yGC0GC1GC2GC3GC4GC5yGAAGABGC6GC7GC8GC9GCAG88的GCBGCCGA2GAAGABGCDGCE延GB8GB7GB8GCFGD0肾k腺素能通GD1GBBGBCGBDGBFPGD2GD3和其GD4GD5GD6性GD7GD8的GADGD9yG99G9A镇GC7G9CG9D48D右美托咪陡对心血管G81G82的G9CG9D是降低GDAGDB神G80G81G82的GDCGDD性y降低GAE血GDEGDFGD3GE0和GE1GE2GE3GE4GE5GE6yGE7GACGAEGE8激GE9GE8yGEAGEB降低血压和心率y有GECGED降低GEE管和拔管时血GEF动GF0GF1GE9GE8yG8FG90患者心血管GF2能的GF3GF4911DScheinin12GF5GB0GB1y麻醉GF6GCCGBDGF7GF80.6ug/kg右美托咪陡y能GF9降低血GDEGCFGD0肾k腺素GE5GE6yGFAGFBGFCGFDGFEGFF和气管GEE管G8C起的心血管GE9GE8DTalke13GF5对GCE血管手术的患者yG91麻醉GF6GCCGBD20min开始yGF7GF8右美托咪陡至手术结柬GB948hyG8D现右美托咪陡可有GECGAAGAB麻醉苏醒期间心率增快及血GDEGCFGD0肾k腺素分泌的增多DGAFGB0GB1表明GEE管即刻拔管即刻DGB2的MAPHR和RPP与CGB2比较差异有G82计GF1意义yG9E也证实GAEG9FkGB0GB1DGF7GF81ug/kg右美托咪陡初期y会出现短暂的血压升高y随着时间延长y才逐渐出现降压和降心率的G9CG9DDGAFGB0GB1显示yDGB2在注药GB910min的MAP比基础值升高y但注药GB915min的MAP与基础值比较差异无G82计GF1意义DDGB2在注药GB910min15min的HR比基础值GCD降y但无G8DG9A严重的心动过GE7D出现暂时性的血压升高主要是GA1激血管平滑肌G99G9A直接外周血管收缩GECGE8的结果D暂时性高血压通常不需要治疗y可通过GE7慢输注速GE610minGE7GACy故禁忌快速静脉注射GF7药D如果有心率明显GCD降yGE8GC0G9D阿托品GF5药GD2保G90心率D综k所述y通过GAFGB0GB1的临床观察y麻醉GF6GCCGBDGF7GF8右美托咪陡能显著GFA轻全身麻醉气管GEE管和拔管G8C起的心血管GE9GE8y降低心肌氧耗yG8FG90血GEF动GF0GF1GF3GF4y同时不延长术GB9苏醒时间和拔管时间y对麻醉恢复期没有影响D参考文献CarolloDSyNossamanBDyRamadhyaniU.DexmedetomidineIareviewofclinicalapplicationsJ.CurrOpinAnaesthesioly2008y214I457461.GerlachATyMurphyCVyDastaJF.AnupdatedfocusedreviewofdexmedetomidineinadultsJ.AnnPharmacothery2009y4312I20642074.GobelFLyNorstromLAyNelsonRRyetal.Theratepressureproductasindexofmyocardialoxygenconsumptionduringexerciseinpatients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