右美托咪定对老年高血压患者全麻诱导气管插管应激反应的影响

目的：比较不同剂量右美托咪定对老年高血压患者全麻诱导期间气管插管引起的血流动力学反应的影响。方法将60～75岁、ASAⅠ～Ⅱ级行全麻手术的原发性高血压患者60例，分为3组，D1、D2组和对照组（C组），每组20例。D1、D2组于麻醉诱导前15 min ，采用微量泵将4μg/mL的右美托咪定分别以0.2、0.6μg/kg剂量静脉泵入，在10 min内完成；C组以同样方法泵入0.9％氯化钠溶液。分别记录3组患者在试验用药前（T0）、诱导前（T1）、气管插管前（T2）、插管后1 min（T3）、5 min（T4）的平均动脉压（MAP）、心率（HR）、血氧饱和度（SpO2）值。同时检测血浆去甲肾上腺素（NE）和肾上腺素（E）值。结果与用药前相比，D2组MAP在诱导前明显降低（P＜0.05），C组和D1组则无明显变化（P＞0.05）；D2组 HR在插管后1 min明显减慢（P＜0.05），而C和D1组HR在插管后1 min显著增快（P＜0.05）。与C组相比，D2组在诱导前、插管前、插管后1 min、插管后5 min MAP和HR均明显降低（P＜0.05），SpO2仅在诱导前有所下降（P＜0.05）；D1组各个时点的MAP、HR、SpO2与C组相比均无明显差异（P＞0.05）。与T0相比，T1时D2组血浆NE和E值降低（P＜0.01）；T3时C、D1组血浆NE和E值升高，D2组则降低（P＜0.01）。与C组相比，T1和T3时D2组血浆NE和E值均降低（P＜0.01）。结论静脉注射右美托咪定可安全抑制老年高血压患者全麻诱导时气管插管引起的血流动力学变化，维持老年高血压患者全麻诱导及气管插管期间循环功能稳定。并且0.6μg/kg的右美托咪定比0.2μg/kg能更加有效抑制气管插管引起的应激反应。

Influence of dexmedetomidine on intubation stress reactions under general anesthesia induction in senile hypertension patients

Objective To compare the influence of different doses of dexmedetomidine on the haemodynamic response caused by tracheal intubation during general anesthesia induction in senile hypertension patients .Methods Sixty patients with essential hy‐pertension(EH) undergoing general anesthesia operation ,60-75 years old ,ASAⅠorⅡ ,were randomly divided into the group D1 , D2 and control group(C) ,20 cases in each group .4μg /mL dexmedetomidine in the group D1 and D2 was intravenously pumped at 15 min before anesthesia induction with the doses of 0 .2 ,0 .6 μg/kg respectively and completed within 10 min;while the group C was pumped with sodium chloride injection by the same method .Mean artery pressure (MAP) ,heart rate (HR) and O2 saturation (SpO2 ) were monitored at before medication(T0) ,before induction(T1) ,before intubation(T2) ,at 1 min(T3) ,5 min(T4) after tra‐cheal intubation .Meanwhile plasma norepinephrine(NE) and epinephrine(E) values were detected .Results Compared with before medication ,MAP before induction in the group D2 was significantly decreased (P<0 .05) ,however which in the group D1 and C had no obvious change(P>0.05);HR at 1 min after tracheal intubation in the group D2 was significantly decreased (P<0.05) , while which in the group C and D1 was significantly increased(P<0 .05) .Compared with the group C ,MAP and HR before induc‐tion and tracheal intubation ,at 1 ,5 min after tracheal intubation in the group D2 were significantly decreased(P<0.05) ,SpO2 was significantly decreased only before induction (P<0.01);MAP ,HR and SpO2 at each time points in the group D1 had no significant differences compared with the group C(P>0.05) .Compared with T0 ,the plasma levels of NE and E at T1 in the group D2 were decreased (P<0.01);the plasma levels of NE and E at T3 in the group C and D1 were increased ,while which in the group D2 were decreased (P<0.01) .The plasma levels of NE and E at T1 and T3 in the group D2 were decreased compared with the group C(P<0.01) .Conclusion Intravenous injection of dexmedetomidine can safely inhibit the tracheal intubation caused hemodynamic changes and keep the hemodynamic stabilization during general anaesthesia induction and tracheal intubation period in senile hyper‐tension patients .Furthermore dexmedetomidine 0.6μg/kg can more effectively inhibit the tracheal intubation caused stress reac‐tions than dexmedetomidine 0.2μg/kg .