右美托咪啶对胃肠手术患者全身麻醉诱导期的影响

目的评估全身麻醉前靶控输注右美托咪啶对全身麻醉诱导期的影响。方法 40例全麻下择期行胃肠手术患者随机分为安慰剂组(PLACEBO)和右美托咪啶组(DEX),各20例。诱导前两组患者分别接受静脉靶控输注右美托咪啶(血浆靶浓度0.6ng/ml)或等量生理盐水,持续输注15min;随后靶控输注异丙酚、静脉注射芬太尼和顺式阿曲库铵进行麻醉诱导,观察血流动力学、意识及不良应激反应变化。记录入睡时间及入睡时异丙酚血浆浓度。高效液相色谱法检测诱导前以及气管插管后10min血浆中肾上腺素(E)和去甲肾上腺素(NE)含量。结果 DEX组在麻醉诱导期间平均动脉血压表现平稳,与基础值相比,PLACEBO组平均动脉血压在气管插管前以及气管插管后10min显著降低,P0.05。DEX组入睡时间较PLACEBO组明显缩短,DEX组入睡时异丙酚血浆浓度较PLACEBO组明显降低,插管时DEX组血浆肾上腺素(E)和去甲肾上腺素(NE)明显降低,均0.05。结论麻醉诱导期P靶控输注右美托咪啶可减少血浆肾上腺素和去甲肾上腺素,稳定血流动力学,同时可减少全身麻醉诱导期异丙酚用量。

Effect of dexmedetomidine hydrochloride by target controlled perfusion on period of induction of general anesthesia in patients with abdominal operations

Objective To evaluate the effects of dexmedetomidine hydrochloride by target controlled perfusion on period of induction of general anesthesia.Methods Forty patients were admitted for abdominal operation in general anesthesia were randomly assigned into the placebo group（PLACEBO）and dexmedetomi-dine group（DEX）.Two groups received dexmedetomidine hydrochloride by target controlled perfusion（plasma concentration 0.6 ng/ml）or tales doses of saline for 15 min before induction.Then general anesthesia was induct-ed by target controlled perfusion of propofol,intravenous injection of fentanyl and cisatracurium.Hemodynam-ics,consciousness and distress reaction were observed.The time to fall sleep and the plasma concentration of propofol were recorded.Blood epinephrine and norepinephrine before induction and 10 minutes after intubation were detected by high efficiency liquid chromatography.Results Hemodynamics in DEX presented more stable during the whole period of induction.Compared with baseline,MAP in PLACEBO group decreased significantly before intubation and 10 min after intubation,0.05.Compared with those in PLACEBO group,patients in P DEXgroup falled sleep fasterwith significant lower dose of propofol,0.05.Blood epinephrine and norepinephrine P in DEX group were significant lower than that in PLACEBO group when intubation,P0.05.Conclusions Target controlled perfusion of dexmedetomidine hydrochloride with 0.6 ng/ml plasma concentration for 15 min-utes before induction decreases blood epinephrine and norepinephrine with more stable hemodynamics.It also reduces the dosis of propofol in the period of induction.