摘要
目的 探讨右美托咪定(dexmedetomidine, Dex)对急性颅脑外伤患者围术期血流动力学和血浆儿茶酚胺 (catecholamines, CAs) 水平的影响。 方法 急性颅脑外伤Ⅲ级患者40例,按随机数字表法分为Dex组(D组)和生理盐水组(C组),每组20例,D组患者在麻醉诱导前10 min静脉推注Dex 0.5 μg/kg,继以0.2 μg·kg-1·h-1~0.7 μg·kg-1·h-1静脉泵注,C组患者给予等量的生理盐水。观察记录患者入室(T1)、麻醉诱导前(T2)、气管插管后1 min(T3)、手术1 h(T4)和拔除气管导管后(T5)的平均动脉压(mean arterial pressure, MAP)和心率(heart rate, HR),同时检测这5个时间点患者血浆肾上腺素(epinephrine, E)、去甲肾上腺素(norepinephrine, NE)水平。 结果 D组T2、T3、T4和T5时点MAP[(95±9)、(87±9)、(80±8)、(90±9) mmHg(1 mmHg=0.133 kPa)]明显低于T1时点[(112±10) mmHg](P〈0.05),D组T2、T3、T4和T5时点HR[(92±7)、(75±8)、(65±5)、(85±7) 次/min]明显低于T1时点[(110±9) 次/min](P〈0.05),D组T2、T3、T4和T5时点E[(93±8)、(78±7)、(75±8)、(87±7) ng/L]明显低于T1时点[(110±10) ng/L](P〈0.05),D组T2、T3、T4和T5时点NE水平[(378±35)、(355±34)、(335±35)、(362±32) ng/L]明显低于T1时点[(420±40) ng/L](P〈0.05),C组T2和T5时点各指标与T1时点比较差异无统计学意义,而T3和T4时点明显低于T1时点(P〈0.05)。C组T2、T3、T4和T5时点各指标明显高于D组(P〈0.05)。 结论 全麻辅助应用Dex能维持患者的血流动力学稳定,并抑制E和NE的释放,明显抑制急性脑外伤患者的应激水平。
Objective To investigate the effects of dexmedetomidine(Dex) on the perioperative hemodynamics and level of catecholamine(CAs) in acute craniocerebral injury. Methods Forty patients under acute craniocerebral trauma level 3 were randomly divided into the Dex group (group D, n=20) and the control group (group C, n=20). None of the groups received pre-operative medication. In group D, the patients received intravenous injection of Dex (0.5 μg/kg) 10 min before anesthesia induction, and then received continuous infusion of Dex at a rate of 0.2 μg·kg-1·h-1-0.7 μg·kg-1·h-1 during the operation, while in group C, the patients were given the same amount of saline. Mean arterial pressure(MAP) and heart rate(HR) were recorded into the operate room(T1), before the induction of anesthesia(T2), 1 min after intubation(T3), 1 h after incision(T4), and after extubation(T5). Meanwhile, the levels of plasma epinephrine(E) and norepinephrine(NE) were measured at the five time points. Results MAP and HR at T2, T3, T4 and T5[(95±9),(87±9),(80±8),(90±9) mmHg(1 mmHg=0.133 kPa). (92±7),(75±8),(65±5),(85±7) bpm] were significantly lower than those of T1 [(112±10) mmHg,(110±9) bpm] in group D(P〈0.05). Levels of E and NE at T2, T3, T4 and T5[(93±8),(78±7),(75±8),(87±7) ng/L. (378±35),(355±34),(335±35),(362±32) ng/L] were significantly lower than those of T1 [(110±10) ng/L,(420±40) ng/L] in group D(P〈0.05). Compared with those of T1, MAP and HR were not changed significantly at T2 and T5, and significantly decreased at T3 and T4 in group C(P〈0.05). The levels of E and NE at T2, T3, T4 and T5 were significantly lower than those of T1 in group D(P〈0.05). Compared with that of T1, the levels of E and NE were not changed significantly at T2 and T5 and were significantly decreased at T3 and T4 in group D(P〈0.05). Conclusions During acute craniocerebral trauma operation under general anesthesia, Dex could stabilize hemodynamics, decrease the release of E and NE, and inhibit the stress response.
出处
《国际麻醉学与复苏杂志》
CAS
2014年第4期309-311,316,共4页
International Journal of Anesthesiology and Resuscitation
关键词
右美托咪定
颅脑外伤
儿茶酚胺
血流动力学
Dexmedetomidine
Craniocerebral trauma
Catecholamines
Hemodynamics