右美托咪定对全麻下脑功能区肿瘤切除术唤醒试验中应激反应的影响

发布时间：2018-09-14 15:06

【摘要】：目的评价右美托咪定对丙泊酚联合瑞芬太尼全麻下脑功能区肿瘤切除术患者唤醒试验中应激反应的影响。方法拟行术中唤醒试验的脑功能区肿瘤切除术患者48例,随机均分为右美托咪定组和对照组,右美托咪定组麻醉诱导前10min将负荷量0.8μg/kg右美托咪定进行静脉输注,继以0.4μg·kg-1·h-1进行维持;对照组采用等量生理盐水进行静脉输注。丙泊酚和瑞芬太尼靶控输注进行麻醉诱导与维持,于唤醒试验前30min停用丙泊酚和肌松药,调整瑞芬太尼血浆浓度为1ng/ml,右美托咪定组输注速率0.1μg·kg-1·h-1。记录两组患者唤醒前麻醉时间、麻醉药用量和唤醒时间,分别于唤醒前30min(T1)、唤醒时(T2)、唤醒后5min(T3)和研究结束后加深麻醉10min(T4)时,记录两组患者MAP、HR和BIS值,及血浆中去甲肾上腺素(NE)和肾上腺素(E)浓度,记录两组患者唤醒期间不良反应发生情况。结果两组患者唤醒时间、唤醒前麻醉时间和顺阿曲库铵用量差异无统计学意义。与对照组比较,右美托咪定组患者唤醒前丙泊酚和瑞芬太尼用量明显减少(P0.05)。与T1时比较,T2和T3时两组患者MAP和BIS均明显升高、HR明显增快(P0.05)。与对照组比较,T2和T3时右美托咪定组MAP明显降低(P0.05),T1~T4时HR明显减慢(P0.05),T1~T4时右美托咪定组患者NE和E浓度明显降低(P0.05),右美托咪定组患者躁动、心动过速、呛咳和高血压发生率均明显降低(P0.05)。各时点两组BIS值差异无统计学意义。结论右美托咪定对丙泊酚联合瑞芬太尼全麻下脑功能区肿瘤切除术唤醒试验中应激反应有较好的抑制作用,能够降低血浆NE和E浓度,对血流动力学影响较小,不良反应发生率降低。
[Abstract]:Objective to evaluate the effect of dexmetomidine on stress response in patients undergoing brain functional area tumor resection under general anesthesia with propofol and remifentanil. Methods Forty-eight patients undergoing intraoperative arousal test were randomly divided into two groups: dexmetomidine group and control group. Before anesthesia induction, 10min received intravenous infusion of 0.8 渭 g/kg dexmetomidine in dexmetomidine group. Then maintained with 0.4 渭 g kg-1 h-1, the control group received intravenous infusion of the same amount of normal saline. Propofol and remifentanil were induced and maintained by target-controlled infusion. Propofol and muscle relaxant were stopped by 30min before arousal test. The plasma concentration of remifentanil was adjusted to 1 ng / ml, and the infusion rate of dexmetoimidine was 0.1 渭 g kg-1 h-1. The anaesthesia time before arousal, the dosage of anesthetic and the arousal time were recorded, and the MAP,HR and BIS values were recorded at 30min (T1), wake-up (T2), 5min (T3) after arousal and 10min (T4) after the end of the study, respectively. Plasma norepinephrine (NE) and epinephrine (E) concentrations were recorded. Results there was no significant difference in arousal time, anaesthesia time before arousal and the dosage of cisatracurium between the two groups. Compared with the control group, the dosage of propofol and remifentanil before arousal was significantly decreased in dexmetomidine group (P0.05). Compared with T 1, T 2 and T 3, MAP and BIS were significantly increased in both groups (P0.05). Compared with the control group, the MAP of right metoimidine group was significantly lower than that of control group (P 0.05). The HR of right metoimidine group was significantly lower than that of control group (P 0.05). The concentration of NE and E in right metoimidine group was significantly lower than that in right metoimidine group at T4 and T4 (P0.05), while the patients in right metoimidine group were restless and tachycardia. The incidence of cough and hypertension decreased significantly (P0.05). There was no significant difference in BIS between the two groups at each time point. Conclusion dexmetomidine has a good inhibitory effect on stress response in brain functional area tumor resection under general anesthesia with propofol and remifentanil. It can reduce plasma NE and E concentrations and have little effect on hemodynamics. The incidence of adverse reactions decreased.
【作者单位】：河南省新乡市中心医院麻醉科;
【分类号】：R614;R739.4

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