右美托咪定对七氟醚诱导气管插管时血流动力学及镇静深度的影响

发布时间：2019-06-17 08:22

【摘要】：目的观察右美托咪定对七氟醚诱导气管插管时血流动力学及镇静深度的影响。方法全麻下行择期耳鼻喉手术患者36例,随机分为F2组、F4组、DF2组。连续监测心率、动脉血压、脉氧饱和度、脑电双频指数。记录给右美托咪定或0.9%氯化钠溶液之前(T0)、麻醉诱导前即刻(T1)、吸入七氟醚麻醉诱导后2 min时(T2),气管插管前即刻(T3),气管插管后即刻(T4)患者的心率(HR)、收缩压(SBP)、舒张压(DBP)、脑电双频指数(BIS);并于T0、T1、T3、T4时抽取静脉血,测量血糖值(BG)。结果在F2和F4组内,SBP、DBP、HR、BIS在T2时与T1时比较,显著降低(P0.05);SBP、DBP、HR、BIS在T4时与T3时比较,显著升高(P0.05);血糖在T4时与T2时比较,显著升高(P0.05)。在DF2组内,SBP、HR、BIS在T1时与T0时比较,显著降低,血糖显著升高(P0.05);SBP、BIS在T2时与T1时比较,显著降低(P0.05)。与DF2组比较,F2组T1时刻HR、BIS较高(P0.05),T2、T3时刻SBP较低(P0.05),T4时刻SBP、DBP、HR、BIS较高(P0.05);F4组T1时刻HR、BIS较高(P0.05),T2、T3时刻SBP、DBP较低(P0.05);F2组和F4组在T1、T3、T4时刻血糖较低(P0.05)。与DF2组比较,F2组和F4组麻醉诱导引起的SBP、DBP、HR下降幅度较大(P0.05),F2与F4组间比较差异无统计学意义(P0.05)。与DF2组比较,F2组气管插管导致的SBP、DBP、HR升高幅度较大(P0.05);F4组SBP、DBP升高幅度较大(P0.05);与F2组比较,F4组SBP、DBP、HR升高幅度较小(P0.05)。结论右美托咪定可维持七氟醚麻醉诱导后血流动力学平稳,抑制气管插管导致的心血管反应,使诱导插管过程血流动力学更加平稳。右美托咪定还可降低BIS值,产生明显镇静效应。
[Abstract]:Objective to observe the effect of dexmetomide on hemodynamics and sedation depth during sevoflurane-induced endotracheal intubation. Methods 36 patients undergoing elective otorhinolaryngectomy under general anesthesia were randomly divided into F 2 group, F 4 group and DF2 group. Heart rate, arterial blood pressure, pulse oxygen saturation and EEG bispectral index were continuously monitored. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), bispectral index (BIS); was recorded immediately before anesthesia induction (T 1), 2 min after inhaled sevoflurane anesthesia (T 2), immediately before tracheal intubation (T 3) and immediately after endotracheal intubation (T 4) and at T 0, T 1, T 3, T 4, and the blood glucose value was measured at T 0, T 1, T 3 and T 4 respectively, and the blood glucose value was measured immediately before intubation (T 0), immediately before anesthesia induction (T 1), 2 min after anesthesia induction (T 2), immediately before tracheal intubation (T 3). Results in F2 and F4 groups, SBP,DBP,HR,BIS at T2 was significantly lower than that at T1 (P 0.05), SBP,DBP,HR,BIS at T 4 was significantly higher than that at T 3 (P 0.05), and blood glucose was significantly higher at T 4 compared with T 2 (P 0.05). In DF2 group, SBP,HR,BIS decreased significantly and blood glucose increased significantly at T 1 and T 0, and SBP,BIS decreased significantly at T 2 compared with T 1 (P 0.05). Compared with DF2 group, F2 group had higher HR,BIS at T1 time (P05), T2, T3 time SBP was lower (P05), T3 time SBP,DBP,HR,BIS was higher (P05), F4 group T1 time HR,BIS was higher (P05), T2, T3 time SBP,DBP was lower (P05); F2 group and F4 group were T1, T3, T4 time blood glucose was lower (P05). Compared with DF2 group, the decrease of SBP,DBP,HR induced by anesthesia in F _ 2 group and F _ 4 group was larger (P 0.05), but there was no significant difference between F _ 2 group and F _ 4 group (P 0.05). Compared with DF2 group, the increase of SBP,DBP,HR caused by endotracheal intubation in F _ 2 group was larger (P 0.05), that in F _ 4 group was larger than that in F _ 2 group (P 0.05), and that in F _ 4 group was smaller than that in F _ 2 group (P 0.05). Conclusion dexmetomide can maintain the hemodynamic stability after sevoflurane anesthesia induction, inhibit the cardiovascular response caused by tracheal intubation, and make the hemodynamics more stable during induction intubation. Dexmetiomidine can also reduce the BIS value and produce obvious sedation effect.
【作者单位】：湖北省宜都市第一人民医院麻醉科;
【分类号】：R614

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