右美托咪定对微创McKeown食管癌根治术患者术中尿量的影响

发布时间：2018-06-07 09:11

本文选题：右美托咪定 + 食管肿瘤　；参考：《中国新药与临床杂志》2015年11期

【摘要】：目的探讨右美托咪定(Dex)对微创Mc Keown食管癌根治术患者术中尿量的影响及其机制。方法择期行微创Mc Keown食管癌根治术的患者60例(ASAⅠ~Ⅱ级),随机分为3组,每组20例。Dex1组、Dex2组麻醉诱导前,予Dex 1μg·kg-1静脉泵注,15 min泵完,后以0.2、0.4μg·kg-1·h-1维持至手术结束;对照组予等量氯化钠注射液静脉泵注。术中监测患者生命体征,记录每小时尿量,采用放射免疫法测定6个时点(术前,术中1、2、3 h,术毕,术后2 h)血浆抗利尿激素(ADH)、醛固酮(ALD)、心房钠尿肽(ANP)浓度。结果 Dex1组、Dex2组患者尿量从术中2 h开始增高,且Dex2组增高程度高于Dex1组(P0.05)。3组血浆ADH浓度围术期均无明显变化,术中1 h Dex1组、Dex2组血浆ALD浓度开始下降,低于术前和对照组(P0.05),Dex1组、Dex2组间各时点无显著差异(P0.05)。Dex1组、Dex2组血浆ANP浓度从术中1 h起增高,术中3 h达高峰,术中各时点均高于对照组(P0.05),两组之间各时点均无显著差异(P0.05)。结论 Dex应用于微创Mc Keown食管癌根治术患者具有利尿作用,可能通过抑制肾素-血管紧张素-醛固酮系统和增加ANP释放使患者尿量增加。
[Abstract]:Objective to investigate the effect and mechanism of dexmetomidine Dexon on urine volume in patients undergoing minimally invasive Mc Keown radical resection of esophageal carcinoma. Methods Sixty patients undergoing minimally invasive Mc Keown radical resection of esophageal carcinoma were randomly divided into 3 groups. 20 cases in each group were given Dex 1 渭 g kg-1 infusion 15 min before anesthesia induction, and then maintained with 0.2 渭 g kg-1 h-1 until the end of the operation. The control group received the same amount of sodium chloride injection intravenous pump. Vital signs were monitored and urine volume per hour was recorded. Plasma antidiuretic hormone (ADH), aldosterone (ALD) and atrial natriuretic peptide (ANPs) were measured at 6 time points (preoperative, intraoperative 2 h, postoperative 2 h) by radioimmunoassay. Results the urine volume in Dex1 group was increased from 2 hours after operation, and the level of plasma ADH in Dex2 group was higher than that in Dex1 group (P 0.05). The plasma ALD concentration in Dex1 group began to decrease 1 h after operation. There was no significant difference in plasma ANP concentration between Dex2 group and control group. Plasma ANP concentration in Dex2 group increased from 1 hour during operation, reached the peak at 3 h during operation, and was higher than that in control group (P 0.05) at each time point. There was no significant difference between the two groups at each time point. Conclusion Dex has diuretic effect in patients undergoing minimally invasive Mc Keown radical resection of esophageal cancer. It may increase urine volume by inhibiting renin-angiotensin-aldosterone system and increasing ANP release.
【作者单位】：温州医科大学附属第一医院麻醉科;
【分类号】：R614;R735.1

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