右美托咪啶对老年患者双腔支气管插管诱发心血管反应的影响

目的为了观察预注右美托咪啶对老年肺癌患者插入双腔气管导管（DLT）诱发心血管反应的影响。方法选择60例年龄65—80岁，体重45～75kg，ASAⅠ～Ⅱ级择期行肺癌手术的患者，随机分为右旋美托咪啶组（D组）和对照组（c组），每组30例．D组右旋美托咪啶1μg／kg，用生理盐水配制成4μg／L的浓度，麻醉前15min内静脉注射完毕．c组持续输注同等容量生理盐水作对照．麻醉诱导：静脉注射芬太尼4μg/kg，依托咪酯0．3mg／kg，顺阿曲库铵0．15mg／kg，给完药后4分钟行双腔支气管插管，成功后接麻醉机行机械通气。观察患者输注右美托咪啶前（T0），泵注右美托咪啶或生理盐水结束时（T1）、气管插管前（T2）、气管插管即刻（T3）、气管插管后1min（T4）、3min（T5）及5min（T6）各时间点的动脉收缩压（SAP）、舒张压（DAP）、平均动脉压（MAP）、和心率（HR）的数值。结果两组间T0时SAP、DAP、MAP和HR相比差异无统计学意义（P〉0．05）。T1和T2时，D组SAP、DAP、MAP均较C组升高（P〈0．05）；D组T1时HR比C组降低（P〈0．05）。T3至T6时，D组患者的SAP、DAP、MAP和HR均比c组要低沪〈0．05）。结论全麻诱导前静脉输注右美托咪啶可有效抑制老年肺癌患者双腔支气管插管诱发的心血管反应，维持血流动力学稳定。

Effect of dexmedetomidine on cardiovascular response to bronchial intubation of double lumen tube in elderly patients

Objective To explore the effect of dexmedetomidine on cardiovascular response to intubation of double lumen tube in elderly patients with lung cancer. Methods 60 patients aged 65-80 years, weighing 45- 75 kg, ASA I or lI , scheduled for elective thoracic surgery were randomly assigned into dexmedetomidine group （group D, n=30） and controlled group （group C, n=30）. In group D, dexmedetomidine 1 tx g/kg was infused by syringe pump for 15 min while equal volume of normal saline was given in group C before induction. Anesthesia was induced with fentanyl 4 Ix g/kg, etomidate 0.3 mg/kg and atracuruim 0.15 mg/kg. After bronchial intubation was performed, the patients were mechanically ventilated. Systolic and diastolic arterial pressure （SAP, DAP）, mean arterial pressure （MAP） and heart rate （HR） were recorded before infusion （ TO ） , ending of infusing dexmedetomidine or normal saline （ T1 ） , before bronchial intubation （ T2 ） , instance of bronchial intubation （ T3 ） , lmin, 3min and 5min after bronchial intubation （ T4-6 ） . Results There was no significant difference of SAP, DAP, MAP and HR at TO between the two groups （P 〉 0.05 ） .Compared with group C, SAP, DAP, MAP and HR at T1 and T2 in group I） were significantly increased. HR at T1 in group D was obviously lower than that of group C （P 〈 0.05 ） . At T3-6, SAP, DAP, MAP and HR in group D were significantly lower than those in group C （P 〈 0.05 ） . Conclusion Intravenous infusing dexmedetomidine before induction of general anesthesia can effectively inhibit the cardiovascular response caused by bronchial intubation in elderly patients with lung cancer and maintain the stability of hemodynamics.