摘要
目的评价不同剂量右美托咪定对于合并高血压行腹腔镜胆囊切除术的患者在气管拔管期间的血流动力学的影响。方法选择2013年12月-2014年12月合并高血压拟全身麻醉下行腹腔镜胆囊切除术的患者120例,随机分为4组:生理盐水对照组(C组)、低剂量盐酸右美托咪定组(D1组)、中剂量盐酸右美托咪定组(D2组)、高剂量盐酸右美托咪定组(D3组),每组各30例。每组麻醉方法与药物均相同,在手术结束前15 min,C、D1、D2、D3组分别给予20 m L生理盐水,0.25、0.50、1.00μg/kg的右美托咪定(用生理盐水稀释至20 m L),给药时间都设置为15 min。分别观察记录各组在给药前(T1)、给药后即刻(T2)、拔管即刻(T3)、拔管后1 min(T4)、拔管后5 min(T5)患者的平均动脉压(MAP)和心率,以及患者的手术时间、苏醒时间、拔管时间及不良反应发生情况。结果组内比较,C组、D1组在T3、T4、T5时间点较T1、T2时间点MAP和心率明显升高(P<0.05),D2组、D3组在T3、T4、T5时间点较T1、T2时间点MAP和心率差异无统计学意义(P>0.05);与C组相比,D1组在T3、T4、T5时间点MAP和心率降低无统计学意义(P>0.05);而D2组和D3组在T3、T4、T5时间点MAP和心率降低较C组和D1组有统计学意义(P<0.05);拔管后C组2例患者出现躁动,D1、D2、D3组无躁动、恶心、寒战等不良反应,但D3组出现2例嗜睡。结论手术结束前15 min静脉缓慢注射中等剂量的右美托咪定能有效减轻合并高血压行腹腔镜胆囊切除术患者拔管期的心血管应激反应,推荐右美托咪定剂量为0.50μg/kg。
Objective To evaluate the effect of different doses of dexmedetomidine on hemodynamics during endotracheal extubation of laparoscopic cholecystectomy in patients with hypertension. Methods A total of 120 hypertension patients ready to undergo laparoscopic cholecystectomy under general anesthesia between December 2013 and December 2014 were chosen to be our study subjects. They were randomly divided into 4 groups with 30 patients in each： saline control group（group C）, low-dose dexmedetomidine hydrochloride injection group（group D1）, moderatedose dexmedetomidine hydrochloride injection group（group D2）, and high-dose dexmedetomidine hydrochloride injection group（group D3）. The anesthesia methods and drugs were kept the same in each group, and 20 m L of saline, 0.25, 0.50, 1.00 μg/kg dexmedetomidine（diluted to 20 m L with saline） were given to group C, D1, D2, and D3 respectively 15 minutes before the end of surgery. Time of drug administration was set to 15 minutes. We observed and recorded each patient＇s mean arterial pressure（MAP） and heart rate（HR） in 5 particular moments： the time point before administration（T1）, immediately after administration（T2）, extubation after administration（T3）, one minute after extubation（T4）, and 5 minutes after extubation（T5）. Surgery time, recovery time, extubation time and the number of adverse reactions were also detected. Results Compared at with, MAP and HR increased significantly at the times points of T3, T4, T5 compared with T1 and T2 in Group C and group D1（P〈 0.05）, while the correspondent difference was not statistically significant in group D2 and D3（P〉 0.05）. Compared with group C, MAP and HR decrease were not significantly at the time points of T3, T4, T5 in group D1（P〉 0.05）. However, MAP and HR decrease at times points of T3, T4, T5 in group D2 and D3 were significantly different from group C and D1（P〈 0.05）. After extubation, there were two cases of dysphoria in group C and two cases of somnolence in group D3, but there were no cases of dysphoria, nausea or shiver in group D1, D2, D3. Conclusion Intravenously injecting moderate dose of dexmedetomidine 15 minutes before the end of surgery can effectively reduce patients＇ cardiovascular stress response during laparoscopic cholecystectomy extubation for patients with hypertension, and we suggest a dose of 0.5 μg/kg of dexmedetomidine.
出处
《华西医学》
CAS
2015年第11期2059-2062,共4页
West China Medical Journal
基金
河北省2013年医学科学研究重点计划(20130674)~~
关键词
右美托咪定
高血压
腹腔镜胆囊切除术
拔管期
血流动力学
Dexrnedetomidine
Hypertension
Laproscopic cholecystectomy
Tracheal extubation
Cardiovascular response
