右美托咪定对后腹腔镜手术患者术中血流动力学的影响

目的探讨右美托咪定对行后腹腔镜手术患者术中血流动力学的影响。方法选择择期后腹腔镜手术40例（ASAⅠ~Ⅱ级）,抽签法分成实验组和对照组。实验组患者给予0.5μg.kg-1右美托咪定泵注10 min,对照组患者给予相同剂量生理盐水,随后行常规诱导插管。术中实验组继续泵注右美托咪定0.4μg.kg-1.h-1,对照组给予同等剂量的生理盐水,记录诱导前（T0）、改变体位后1 min（T1）,切皮后（T2）,气腹后即刻（T3）,气腹后30 min（T4）,气腹后60 min（T5）以及气腹结束时（T6）患者BIS、HR、SBP、DBP、MAP以及血流动力学指标,计算相应时点的全身血管阻力（systemic vascular resistance,SVR）;记录术中每小时的丙泊酚用量及血管活性药物的使用情况。结果 2组间各观察时点血流动力学指标比较除T4时点HR有统计学差异（但无临床意义）外,均无明显差异（P〉0.05）。组内不同时点比较：与T1相比,术中各时间点2组患者HR变化不大（P〉0.05）;与T1相比,对照组T2时点MAP上升并持续到T4（P〈0.05）,而实验组患者仅在T3时点短暂上升。2组患者在气腹后中心静脉压均显著上升并持续到手术结束（P〈0.05）。与T1相比,对照组患者在T3时点心排血量（CO）、心脏排血指数（CI）、每搏量（SV）、每搏指数（SVI）均显著升高（P〈0.05）,且持续到T4,此后由于机体的代偿作用以及手术操作趋于平稳;实验组在气腹过程中CO、CI、SV、SVI等血流动力学指标变化没有显著差异（P〉0.05）。手术过程中对照组患者丙泊酚用量（10.7±3.4）mg/kg,显著多于实验组患者丙泊酚用量（6.8±2.6）mg/kg（t=4.075,P=0.000）。结论右美托咪定诱导及维持用药可以抑制气腹开始后的心血管反应,降低术中丙泊酚的用量。

Effect of Dexmedetomidine on Hemodynamics during Retroperitoneal Laparoscopy

Objective To observe the effect of dexmedetomidine（DEX） on the homodynamic in patients undergoing retroperitoneal laparoscopy. Methods Forty ASA Ⅰ-Ⅱ patients were randomly divided into Groups D and C（control）.Group D received DEX 0.5 μg·kg-1 as bolus before induction（10 minutes） and then 0.4 μg·kg-1·h-1 by infusion during the surgery.Group C received equal volume of normal saline as Group D intravenously without DEX.All the other induction and maintenance drugs were administered in the same way in the two groups.BIS,HR,SBP,DBP,MAP and hemodynamic values were determined before induction（T0）,1 minute after the position being changed（T1）,when the skin was incised（T2） immediately,30 minutes,and 60 minutes afterwards,and in the end of pneumoperitoneum（T3-T6） in all the patients.And then the systemic vascular resistance（SVR） was calculated.During the operation,the consumption of propofol and vasoactive agents were monitored at an hour interval.Results In each group,compared to T1,no significant change was detected in HR at each time points（P0.05）.In Group C,Compared with T1,MAP increased significantly since T2 until T4（P0.05）,while in Group D,MAP only increased transiently at T3.In both the groups,the CVP kept increasing after pneumoperitoneum until the end of the operation（P0.05）.In Group C,the CO,CI,SV and SVI increased significantly at T3 and kept increasing until T4（P0.05）,afterwards it became stable due to the compensation of the body.No significant changes were found in CO,CI,SV,and SVI in Group D during pneumoperitoneum（P0.05）.During the operation,the consumption of propofol in Group C was significantly higher than that in Group D （10.7±3.4） mg/kg vs.（6.8±2.6） mg/kg,t=4.075,P=0.000]. Conclusions Induction and maintenance with DEX can suppress the cardiovascular response caused by pneumoperitoneum and surgery and significantly reduce propofol requirements.