右美托咪定对开颅术后延迟拔管患者应激性激素和血流动力学的影响

目的 探讨右美托咪定预防性用于开颅术后延迟拔管患者镇静时对应激性激素和血流动力学的影响。方法 将入住重症监护病房(intensive care unit,ICU)的择期开颅术后延迟拔管患者采用数字表法随机分配到右美托咪定组或0.9%(质量分数)氯化钠注射液组。分别给予右美托咪定0.6 μg·kg^-1·h^-1 (10 mg/L)或0.9%(质量分数)氯化钠注射液持续泵入至拔管后30 min。测定用药前、用药后2、4、8 h和研究结束时的血中肾上腺素、去甲肾上腺素、多巴胺、皮质醇的浓度,记录心率、收缩压和舒张压。结果 右美托咪定组较0.9%(质量分数)氯化钠注射液组血中去甲肾上腺素、多巴胺和皮质醇的浓度降低(P < 0.05),心率、收缩压和舒张压均明显降低(P < 0.01)。结论 右美托咪定作为一种新型、强效、高选择性的α₂受体激动剂,以0.6 μg·kg^-1·h^-1的速度持续泵入应用于开颅术后延迟拔管患者,可以降低血中应激性激素的水平,稳定血流动力学。

Effect of dexmedetomidine on stress hormone and hemodynamic in delayed extubation patients after craniotomy

Objective To evaluate the effect of dexmedetomidine on stress hormone and hemodynamic in the delayed extubation patients after craniotomy. Methods Forty patients after intracranial surgery with delayed extubation were randomly divided to two treatment study groups, labeled "Dex group" or "Saline group". Dexmedetomidine group patients received a continuous infusion of 0.6 μg·kg^-1·h^-1(10 mg/L). Placebo group patients received a maintenance infusion of 0.9% sodium chloride for injection at a volume and rate equal to that of dexmedetomidine. Plasma levels of epinephrine, norepinephrine, dopamine, cortisol, HR, SBP and DBP were detected at before infusion(T1), 2 hours(T2), 4 hours(T3) and 8 hours(T4) after infusion, end of infusion(T5). Results Plasma levels of norepinephrine, dopamine, cortisol of dexmedetomidine group were lower than those of saline group(P < 0.05). HR, SBP and DBP of dexmedetomidine group were significantly lower than those of saline group(P < 0.01). Conclusion As new sedative and analgesic drugs, use of dexmedetomidine(0.6 μg·kg^-1·h^-1) infusion was able to reduce plasma levels of norepinephrine, dopamine and cortisol, reduce the stress response, maintain hemodynamic stability.