不同剂量右美托咪定对妇科腹腔镜手术围术期血流动力学的影响

目的:观察术前静脉预注射不同剂量右美托咪定对于妇科腹腔镜手术围术期血流动力学的影响.方法:选择ASAⅠ～Ⅱ级择期行妇科腹腔镜手术的患者80例,随机分成对照组(C组)、小剂量组(L组)、中剂量组(M组)和大剂量组(H组),每组20例.C组患者于诱导前静脉输注同等容量的生理盐水;L、M和H组患者分别输注右美托咪定0.2、0.4和0.8μg·kg-1.分别于输注右美托咪定前(T0)、输注右美托咪定10min后(T1)、气管插管即刻(T2)、气管插管后1min(T3)、气腹后10min(T4)、气管拔管即刻(T5)记录患者的收缩压(SBP)、舒张压(DBP)和心率(HR).结果:与T0时比较,TI时M组和H组HR均降低,H组SBP、DBP升高(P<0.05);与T1时比较,T2时C组和L组SBP、DBP和HR降低,T3～T5时SBP、DBP和HR升高(P<0.05);与M组比较,T1～T5时H组SBP、DBP升高(P<0.05).结论:静脉输注右美托咪定剂量0.4μg·kg-1,可有效地维持妇科腹腔镜手术患者的血流动力学稳定,减轻CO2气腹下腹腔镜手术患者的应激反应.

Effects of pretreatment with different doses of dexmedetomidine on hemodynamics during laparoscopic surgery

Objective: To observe the effects of intravenous pretreatment with different doses of dexmedetomidine on hemodynamics during laparoscopic surgery.Methods: Eighty patients(ASA physical statusⅠ-Ⅱ) scheduled for gynecologic laparoscopic surgery were randomly divided into four groups(n=20 in each group): control group(group C),low-dose group(group L),middle-dose group(group M) and high-dose group(group H).Before induction of anesthesia,patients in group C were injected with saline;Patients in group L,M and H were given an intravenous infusion of 0.2,0.4 and 0.8μg·kg-1 dexmedetomidine,respectively.SBP,DBP and HR were recorded the time before infusion of dexmedetomidine(T0),10 minutes after infusion of dexmedetomidine(T1),the time of intubation(T2),1 minute after intubation(T3),10 minutes after pneumoperitoneum(T4) and the time of extubation(T5).Results: Compared with T0,HR was significantly decreased at T1 in group M and H,SBP and DBP were significantly increased at T1 in group H(P<0.05).Compared with T1,BP and HR were significantly lower at T2,while higher at T3 ~T5 in group C and L(P<0.05).BP at T1 ~T5 was significantly higher in group H than in group M(P<0.05).Conclusion: When the dose of dexmedetomidine reaches 0.4μg·kg-1,it may effectively inhibit the stress reaction at intubation and CO2 pneumoperitoneum,and thus stabilize hemodynamia.