[1]秦鹏宇,马闻苛,张红伟,等.右美托咪定对开胸手术患者应激反应及血流动力学的影响[J].新乡医学院学报,2017,34(10):896-900.[doi:10.7683/xxyxyxb.2017.10.008]
　QIN Peng-yu,MA Wen-ke,ZHANG Hong-wei,et al.Effect of dexmedetomidine on stress reaction and hemodynamics in patients underwent thoracotomy[J].Journal of Xinxiang Medical University,2017,34(10):896-900.[doi:10.7683/xxyxyxb.2017.10.008]
点击复制

右美托咪定对开胸手术患者应激反应及血流动力学的影响
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
34
期数:
2017年10
页码:
896-900
栏目:
临床研究
出版日期:
2017-10-05

文章信息/Info

Title:
Effect of dexmedetomidine on stress reaction and hemodynamics in patients underwent thoracotomy
作者:
秦鹏宇; 马闻苛; 张红伟; 李晓芳; 樊　腾; 杨明月; 徐璐丹; 靳广丽; 岳修勤
（新乡医学院第一附属医院麻醉科，河南　卫辉　453100）
Author(s):
QIN Peng-yu; MA Wen-ke; ZHANG Hong-wei; LI Xiao-fang; FAN Teng; YANG Ming-yue; XU Lu-dan; JIN Guang-li; YUE Xiu-qin
（Department of Anesthesia，the First Affiliated Hospital of Xinxiang Medical University，Weihui 453100，Henan Province，China）
关键词:
右美托咪定; 皮质醇; 促肾上腺皮质激素; 应激反应; 开胸手术
Keywords:
dexmedetomidine; cortisol; adrenocorticotropic hormone; stress reaction; thoracotomy
分类号:
R735.1R971+.2
DOI:
10.7683/xxyxyxb.2017.10.008
文献标志码:
A
摘要:
目的　研究右美托咪定对开胸手术患者皮质醇（COR）、促肾上腺皮质激素（ACTH）及血流动力学的影响。方法　择期食管癌根治手术患者40例，采用随机数字表法分为右美托咪定组（观察组）和对照组，每组20例。观察组患者在诱导前泵注负荷剂量的右美托咪定0.8 μg·kg-1，10 min泵注完毕，再以维持剂量0.4 μg·kg-1·h-1的速度持续泵入，手术结束前40 min停用右美托咪定;对照组患者给予等量的生理盐水。2组患者麻醉诱导、维持均相同，术中调整丙泊酚的用量，使脑电双频指数维持在45～60，分别记录麻醉前（T1）、给予负荷剂量的右美托咪定 10 min 后（T2）、诱导前（T3）、气管插管时（T4）、切皮时（T5）、手术1 h（T6）、关胸时（T7）、气管拔管时（T8）、拔管后 5 min（T9）、拔管后15 min（T10）的心率（HR）、血氧饱和度（SpO2）、收缩压（SBP）、舒张压（DBP）数据;检测T1、T5、T6、T8外周静脉血ACTH、COR水平。结果　组间比较显示，2组患者T1、T6、T7、T10时的SBP比较差异均无统计学意义（P>0.05）;T2、T3、T4、T5、T8、T9时观察组患者的SBP显著低于对照组（P<0.05）。2组患者在T1、T8、T9、T10时的DBP比较差异均无统计学意义（P>0.05）;T2、T3、T4、T5、T6、T7时观察组患者的DBP显著低于对照组（P<0.05）。2组患者在T1、T9、T10时的HR比较差异均无统计学意义（P>0.05）;T2、T3、T4、T5、T6、T7、T8时观察组患者的HR显著低于对照组（P<0.05）。2组患者在T1、T4～T10时的SpO2比较差异均无统计学意义（P>0.05）;T2、T3时2组患者的SpO2均在正常范围内，但观察组患者的SpO2显著低于对照组（P<0.05）。2组患者在T1、T5时的COR和ACTH水平比较差异均无统计学意义（P>0.05）;观察组患者在T6、T8时的COR和ACTH水平均显著低于对照组（P<0.05）。组内比较显示，与T1时比较，对照组患者T4、T8、T9时的SBP显著升高（P<0.05），观察组患者T2、T3、T5、T6、T7时的SBP显著降低（P<0.05）。观察组患者T2、T3、T5、T6、T7、T9各时间点的DBP均较T1时显著降低（P<0.05）;对照组患者T4和T8时的DBP较T1时显著升高（P<0.05），T6时的DBP较T1时显著降低（P<0.05）。观察组患者在T8、T9、T10时间点的HR与T1时比较差异均无统计学意义（P>0.05）;T2、T3、T4、T5、T6、T7各时间点的HR与T1时比较均显著降低（P<0.05）。对照组患者在T2、T3、T5、T6、T7、T9、T10各时间点的HR与T1时比较差异均无统计学意义（P>0.05）;在T4、T8时的HR与T1时比较均明显升高（P<0.05）。对照组患者T2～T10各时间点的SpO2与T1时比较差异均无统计学意义（P>0.05）;观察组患者T2、T3时的SpO2均在正常范围内，但与T1时比较均明显降低（P<0.05）。对照组患者T5时的COR和ACTH水平与T1时比较差异均无统计学意义（P>0.05），但T6时的COR和ACTH水平与T1时比较均显著增高（P<0.05）;观察组患者T5和T6时的COR和ACTH水平与T1时比较差异均无统计学意义（P>0.05）;2组患者T8时的COR和ACTH水平与T1时比较均显著升高（P<0.05）。结论　右美托咪定用于开胸手术的复合麻醉，能改善患者血流动力学的稳定性，并能有效抑制机体的应激反应。
Abstract:
Objective　To investigate the effects of dexmedetomidine on cortisol cortisol（COR），adrenocorticotrophic hormone（ACTH） and hemodynamics in patients underwent thoracotomy.Methods　Forty patients with elective radical resection of esophageal carcinoma were randomly divided into dexmedetomidine group （observation group） and control group，20 cases in each group.The patients in the observation group of were injected with loading dose of dexmedetomidine with 10 minutes before induction，then the patients were continuously pumped with maintenance dose of 0.4 μg·kg-1·h-1 dexmedetomidine.The dexmedetomidine was stopped at 40 minutes before the end of surgery.The patients in the control group were given equal dose of normal saline.The methods of anesthesia induction and maintenance were the same in the two groups.The amount of propofol was adjusted during operation，and the bispectral index （BIS） was maintained at 45-60.The heart rate （HR），blood oxygen saturation （SpO2），systolic blood pressure （SBP） and diastolic blood pressure （DBP） were recorded at the time points of before anesthesia （T1），10 minutes after giving a loading dose of dexmedetomidine （T2），before anesthesia induction （T3），tracheal intubation （T4），skin incision （T5），one hours of operation （T6），thoracic closure （T7），tracheal intubation extraction （T8），5 minutes after tracheal intubation extraction （T9） and 15 minutes after tracheal intubation extraction （T10）.The levels of peripheral venous blood ACTH and COR were measured at the time points of T1，T5，T6 and T8.Results　There was no significant difference in SBP between the two groups at T1，T6，T7 and T10 （P>0.05）.The SBP in the observation group was significantly lower than that in the control group at T2，T3，T4，T5，T8 and T9 （P<0.05）.There was no significant difference in DBP between the two groups at T1，T8，T9 and T10 （P>0.05）.The DBP in the observation group was significantly lower than that in the control group at T2，T3，T4，T5，T6 and T7 （P<0.05）.There was no significant difference in HR between the two groups at T1，T9 and T10 （P>0.05）.The HR in the observation group was significantly lower than that in the control group at T2，T3，T4，T5，T6，T7 and T8 （P<0.05）.There was no significant difference in SpO2 between the two groups at T1 and T6-T10 （P>0.05）.The SpO2 of patients in the two groups was normal at T2 and T3，but the SpO2 in the observation group was significantly lower than that in the control group （P<0.05）.There was no significant difference in COR and ACTH levels between the two groups at T1 and T5 （P>0.05）.The levels of COR and ACTH in the observation group were significantly lower than those in the control group at T6 and T8 （P<0.05）.Compared with T1，the SBP of the patients in the control group increased significantly at T4，T8 and T9 （P<0.05）;and the SBP of the patients in the observation group decreased significantly at T2，T3，T5，T6 and T7 （P<0.05）.The DBP at T2，T3，T5，T6，T7 and T9 were significantly lower than those at T1 in the observation group （P<0.05）.Compared with T1，the DBP increased significantly at T4 and T8 （P<0.05），and the DBP decreased significantly at T6 in the control group （P<0.05）.There was no significant difference in HR between T8，T9，T10 and T1 in the observation group （P>0.05）.The HR at T2，T3，T4，T5，T6 and T7 was significantly lower than that at T1 in the observation group （P<0.05）.There was no significant difference in HR between T2，T3，T5，T6，T7，T9，T10 and T1 in the control group （P>0.05）.The HR at T4 and T8 was significantly higher than that at T1 in the control group （P<0.05）.There was no significant difference in SpO2 between T2-T10 and T1 in the control group （P>0.05）.The SpO2 at T2 and T3 was normal in the observation group，but the SpO2 at T2 and T3 was significantly lower than that at T1 （P<0.05）.There was no significant difference in COR and ACTH levels between T5 and T1 in the control group （P>0.05）.The levels of COR and ACTH at T6 were significantly higher than those at T1 in the control group （P<0.05）.There was no significant difference in COR and ACTH levels between T5，T6 and T1 in the observation group （P>0.05）.The levels of COR and ACTH at T8 were significantly higher than those at T1 in the two groups （P<0.05）.Conclusion　Dexmedetomidine can improve the hemodynamic stability and inhibit the stress reaction in the combined anesthesia of patients underwent thoracotomy.

参考文献/References:

［1］　郭新玲，郭忠英，任会杰，等.右美托咪定和咪达唑仑在老年人玻璃体手术中应用的对比研究［J］.眼科新进展，2012，32（8）：784-786.
［2］　张永强，陈胜阳，田建民，等.右美托咪啶对体外循环下瓣膜置换术后患者心肌和肺功能的影响［J］.新乡医学院学报，2017，34（8）：712-716.
［3］　吴运芹，杨志明，喜小明，等.危重足月儿皮质醇、促肾上腺皮质激素水平变化的意义［J］.中华实用儿科临床杂志，2015，30（23）：1821-1824.
［4］　巩红岩，王庆志，岳修勤，等.超声引导连续胸椎旁神经阻滞复合右美托咪定麻醉对食管癌手术患者围术期应激反应的影响［J］.新乡医学院学报，2016，33（4）：291-296.
［5］　全承炫，杨小宇，陈明华，等.右美托咪啶对老年患者术后认知功能和围术期单核细胞Toll样受体2和Toll样受体4表达的影响［J］.中华麻醉学杂志，2011，31（11）：1331-1334.
［6］　王莉，宁杰，李艳华，等.术侧胸椎旁阻滞对单肺通气期间肺内分流及氧合的影响［J］.临床麻醉学杂志，2013，29（6）：564-566.
［7］　VOLKOV P A，CHURADZE B T，SEVALKIN S A，et al.Dexmedetomidine as a part of analgesic component of general anesthesia for laparoscopic operations［J］.Anesteziol Reanimatol，2015，60（1）：4-8.
［8］　RATLIFF B B，RABADI M M，VASKO R，et al.Messengers without borders：mediators of systemic inflammatory response in AKI［J］.J Am Soc Nephrol，2013，24（4）：529-536.
［9］　辜晓岚，何建华，顾连兵，等.超声引导胸椎旁神经阻滞对食管癌手术患者应激反应的影响［J］.临床麻醉学杂志，2015，31（1）：18-21.
［10］　罗明丽，李小华.开胸手术后连续胸椎旁神经阻滞止痛患者的护理［J］.肿瘤基础与临床，2012，25（3）：264-265.

相似文献/References:

[1]杨吉武,唐靖,朱新运,等.右美托咪定对高血压病患者腰硬联合麻醉的镇静效应及血流动力学的影响[J].新乡医学院学报,2012,29(05):359.
[2]贾英萍,李郑琛,邱永升. 右美托咪定滴鼻复合七氟醚吸入麻醉在小儿舌系带成形术中的应用[J].新乡医学院学报,2015,32(08):732.
[3]李克寒１,马　丽２,杨惠敏１,等. 右美托咪定对心脏瓣膜置换术患者的脑保护作用[J].新乡医学院学报,2015,32(08):762.
[4]吕绪磊,郝建华.剖宫产术中应用右美托咪定对子宫收缩剂不良反应的作用[J].新乡医学院学报,2015,32(11):1022.
[5]王晓月,韩子明,张芳敏,等.糖皮质激素对肾上腺皮质的抑制作用研究进展[J].新乡医学院学报,2021,38(1):097.[doi:10.7683/xxyxyxb.2021.01.021]
[6]王　旭,张加强.右美托咪定联合七氟烷在小儿先天性心脏病微创封堵手术中的应用效果[J].新乡医学院学报,2021,38(5):445.[doi:10.7683/xxyxyxb.2021.05.010]
　WANG Xu,ZHANG Jiaqiang.Application effect of dexmedetomidine combined with sevoflurane for children with congenital heart disease undergoing minimally invasive closure operation[J].Journal of Xinxiang Medical University,2021,38(10):445.[doi:10.7683/xxyxyxb.2021.05.010]
[7]周　军,张原源,丛旭晖,等.右美托咪定对全身麻醉扁桃体切除术患儿苏醒期躁动的影响[J].新乡医学院学报,2019,36(4):353.[doi:10.7683/xxyxyxb.2019.04.013]
　ZHOU Jun,ZHANG Yuan-yuan,CONG Xu-hui,et al.Effect of dexmedetomidine on agitation during general anesthesia recovery period in children underwent tonsillectomy[J].Journal of Xinxiang Medical University,2019,36(10):353.[doi:10.7683/xxyxyxb.2019.04.013]
[8]杨　燕,张运琼,黄　沾,等.右美托咪定联合舒芬太尼术后镇痛对脊柱手术患者应激反应、炎症反应、氧化应激及免疫功能的影响[J].新乡医学院学报,2020,37(3):277.[doi:10.7683/xxyxyxb.2020.03.019]
　YANG Yan,ZHANG Yunqiong,HUANG Zhan,et al.Effect of dexmedetomidine combined with sufentanil on stress response,inflammatory response and immune function of patients undergoing spinal surgery[J].Journal of Xinxiang Medical University,2020,37(10):277.[doi:10.7683/xxyxyxb.2020.03.019]
[9]张红伟,王卫卫,李晓芳,等.右美托咪定对咽喉部手术鼾症儿童术后躁动及血流动力学的影响[J].新乡医学院学报,2021,38(8):730.[doi:10.7683/xxyxyxb.2021.08.006]
　ZHANG Hongwei,WAGN Weiwei,LI Xiaofang,et al.Effect of dexmedetomidine on postoperative agitation and hemodynamics of patients with snoring after throat surgery[J].Journal of Xinxiang Medical University,2021,38(10):730.[doi:10.7683/xxyxyxb.2021.08.006]
[10]陈胜阳,张永强,刘　俊,等.右美托咪定对行非体外循环冠状动脉旁路移植术患者肺损伤及血清白细胞介素-10、肿瘤坏死因子-α和克拉拉细胞蛋白16水平的影响[J].新乡医学院学报,2021,38(9):828.[doi:10.7683/xxyxyxb.2021.09.006]
　CHEN Shengyang,ZHANG Yongqiang,LIU Jun,et al.Effects of dexmedetomidine on the lung injury and serum interleukin-10,tumor necrosis factor-α and Clara cell protein 16 levels in patients undergoing off-pump coronary artery bypass grafting[J].Journal of Xinxiang Medical University,2021,38(10):828.[doi:10.7683/xxyxyxb.2021.09.006]

更新日期/Last Update: 2017-10-05