右美托咪啶联合丙泊酚对全麻手术患者血流动力学的影响

目的:观察右美托咪啶联合丙泊酚对全麻手术患者血流动力学的影响。方法:将60例择期行全麻手术患者按随机数字表法均分为氯化钠注射液组(C组)、右美托咪啶组(D1^D4组)。所有患者均给予丙泊酚进行麻醉诱导,C组患者给予氯化钠注射液,D1D4组)。所有患者均给予丙泊酚进行麻醉诱导,C组患者给予氯化钠注射液,D1^D4组患者均给予右美托咪啶。监测5组患者诱导前(T0)、给药后5 min(T1)、10 min(T2)、睫毛反射消失时(T3)、意识消失时(T4)、气管插管前即刻(T5)、气管插管后1 min(T6)、3 min(T7)时的心率(HR)、平均动脉压(MAP)变化;记录睫毛反射消失时、意识消失时丙泊酚效应室浓度(ECC)及剂量;记录患者气管插管阳性反应及不良反应发生情况。结果:C组、D1组患者T5及T6时HR、MAP均显著高于T0时,差异有统计学意义(P<0.05);D2组、D3组患者T1D4组患者均给予右美托咪啶。监测5组患者诱导前(T0)、给药后5 min(T1)、10 min(T2)、睫毛反射消失时(T3)、意识消失时(T4)、气管插管前即刻(T5)、气管插管后1 min(T6)、3 min(T7)时的心率(HR)、平均动脉压(MAP)变化;记录睫毛反射消失时、意识消失时丙泊酚效应室浓度(ECC)及剂量;记录患者气管插管阳性反应及不良反应发生情况。结果:C组、D1组患者T5及T6时HR、MAP均显著高于T0时,差异有统计学意义(P<0.05);D2组、D3组患者T1^T4时HR、MAP均显著低于T0时,差异有统计学意义(P<0.05);D4组患者各时点HR均显著低于T0时,T1、T2时点MAP均显著高于T0时,差异均有统计学意义(P<0.05);D2组、D3组、D4组患者HR较C组、D1组在T2T4时HR、MAP均显著低于T0时,差异有统计学意义(P<0.05);D4组患者各时点HR均显著低于T0时,T1、T2时点MAP均显著高于T0时,差异均有统计学意义(P<0.05);D2组、D3组、D4组患者HR较C组、D1组在T2^T6时点均显著降低,D2组、D3组患者MAP较C组、D1组在T3T6时点均显著降低,D2组、D3组患者MAP较C组、D1组在T3^T6时点均显著降低,差异均有统计学意义(P<0.05);睫毛反射消失时和意识消失时D2组、D3组、D4组患者ECC及剂量较D1组、C组均显著降低,且D3、D4组显著低于D2组,差异均有统计学意义(P<0.05),D2组、D3组患者不良反应发生率显著低于C、D1、D4组患者,且D2组显著低于D3组,差异均有统计学意义(P<0.05)。结论:右美托咪啶联合丙泊酚应用于全麻手术患者,不仅可以维持患者全麻诱导期间血流动力学稳定,还可有效控制患者的应激反应。但是,右美托咪啶用于老年患者麻醉诱导期间的确切疗效和安全性尚须进一步临床研究。

Effects of Dexmedetomidine Combined with Propofol on Hemodynamics in Patients Undergoing General Anesthesia

OBJECTIVE： To observe the effects of dexmedetomidine combined with propofol on hemodynamics in patients undergoing general anesthesia. METHODS： 60 patients undergoing elective general anesthesia surgery were divided into 5 groups by according to random number table method： Sodium chloride injection group （group C）, dexmedetomidine groups （D1-D4 groups）. All patients were given anesthesia induction of propofol. Group C was given Sodium chloride injection, D1-D4 groups were given dexmedetomidine. HR and MAP of 5 groups were monitored at pre-induction （T0）, 5 min （T1） and 10 rain （T2） after treatment, eyelash reflex disappearing （T3,）, loss of consciousness （T4）, laryngoscope （T5）, 1 min （T6） and 3 min （T2） after intubation. The concentrations of propofol effect chamber （ECC） and dose were recorded at T3 and T4. Positive reaction and adverse drug reactions of endotracheal intubation were recorded. RESULTS： Compared with To, HR and MAP in group C and D1 at T5 and T6 increased significantly; there was statistical significance （P〈0.05） ; Compared with T0, HR and MAP of group D2 and D3 were decreased at T1-T4; there was statistical significance （P〈0.05）; compared with T0, HR of group D4 were decreased significantly at various time points; MAP of group D4 were increased significantly at T1 and T2; there was statistical significance （P〈0.05）. Compared with group C and D1, HR in group D2, D3 and D4 at T2 to T6 were decreased significantly; MAP in group D2 and D3 at T3, to T6 decreased significantly; there was statistical significance （P〈0.05） ; the concentration of ECC and dose in group D2, D3, and D4 at T3 to T4 were significantly decreased; and those of group D3, and D4 were lower than group D2; there was statistical significance （P〈 0.05）. In group D2 and D3 , the incidence of ADR was significantly lower than that of group C, D1 and D4; that of group D2 was significantly lower than group D3; there was statistical significance （P〈0.05）. CONCLUSIONS： Dexmedetomidine combined with propofol used in surgery patients undergoing general anesthesia not only keep hemodynamics stable during induction of general anesthesia, but also effectively control stress reaction. But the curative efficacy and safety of dexmedetomidine used in elderly patients during anesthesia induction has yet to be further studied.