右美托咪定滴鼻预处理对患者麻醉手术前身心应激的影响

目的探讨麻醉手术前使用右美托咪定对患者麻醉术前身心应激的抑制程度。方法选择100例20～60岁、ASAⅠ～Ⅱ级的择期手术患者,随机分为两组：实验组（A组）于麻醉前45min鼻内滴注右美托咪定1μg/kg,对照组（B组）麻醉前45min鼻内滴注等容量的生理盐水;分别于用药前后测定患者SBP、DBP、HR、SpO2、焦虑视觉模拟评分（AVAT）、肾上腺素（E）和去甲肾上腺素（NE）的水平。结果对照组患者SBP、DBP、HR、SpO2在用药前后比较差异无统计学意义（P＞0.05）,实验组在用药前后各时间点的SBP、SpO2的变化无统计学意义（P＞0.05）,但在用药后T4、T5时DBP与对照组比较有统计学意义（P〈0.01）;实验组用药后各时点HR开始下降,与用药前及对照组同一时间点比较差异有统计学意义（P〈0.01）。对照组患者在用药45min后AVAT、E、NE的水平明显升高,差异有统计学意义（P〈0.01）;实验组在用药后AVAT明显下降,E、NE的水平明显上升高,差异有统计学意义（P〈0.01）;且两组用药后AVAT、E、NE的水平比较差异有统计学意义（P〈0.01）。结论右美托咪定滴鼻预处理可以减轻麻醉手术前患者的生理和心理应激,是一种安全有效的术前用药。

Effect of dexmedetomidine nasal drop as premedication on the psychophysical stress of patients before anesthesia for surgery

Objective To investigate the inhibition degree of dexmedetomidine（DEX） on patients＇ psychophysical stress before anesthesia for surgery.Methods 100 patients aged from 20 to 60 with ASA of grade Ⅰto Ⅱ , who had been scheduled for surgery, were randomly divided into the experimental group （Group A） and the control group （Group B）.The experimental group were given 1 μg/kg of DEX by intranasal instillation 45 mins before anesthesia, while the control group were given the same volume of saline （also by intranasal instillation）45mins before anesthesia. Then,the SBP,DBP,HR,SpO2 ,anxiety visual analogue scale （AVAT）,level of epinephrine （E） and norepinephrine （NE） before and after operation were tested, respectively.Results Difference of the SBP, DBP, HR and SpOz were not statistically significant before and after operation in the control group（ P 〉0.05）.Difference of SBP and SpO2 of the experimental group at different points in time before and after operation was not statistically significant either （ P 〉0.05）, but comparison of DBP at T4 and T5 after operation between two groups showed statistically significant difference （ P 〈0.01）.HR at different points in time of the experimental group decreased after DEX was given.They were significantly different from those before treatment and those of the control group in the same points in time（ P〈0.01）.45 mins after treatment, the AVAT, E and NE of the control group significantly increased, significantly dif- ferent from those before treatment（ P 〈0.01）. The AVAT of the experimental group significantly decreased after treatment, while their E and NE significantly increased, so the difference was statistically significant（ P 〈0.01）. Moreover, difference in AVAT, E and NE of two groups after treatment were statistically significant（ P 〈0.01）.Conclusion Intranasal dexmedetomidine can reduce the patients ＇ psychophysical stress in anesthesia before surgery. It is a kind of safe and effective premedicati