摘要
目的观察右美托咪定用于全身麻醉维持对脊柱骨折患者围手术期应激反应的影响。方法脊柱骨折择期手术患者60例,随机分为试验组和常规组(对照组),每组30例。麻醉诱导后即刻对试验组患者静脉注射1μg.kg-1右美托咪定,之后以0.5～0.7μg.kg-1.h-1持续泵注维持;常规组以丙泊酚4～6 mg.kg-1.h-1泵注维持作为对照。观察记录两组麻醉诱导前10 min(T0)、气管插管后即刻(T1)、手术进行60 min(T2)、术毕即刻(T3)及拔管时(T4)平均动脉压(MAP)和心率(HR),并于T0、T2和T3时检测血糖和血清皮质醇水平,记录术中芬太尼追加量、患者术后苏醒时间及拔管时呛咳反应评分。结果试验组患者MAP在T1、T4时点高于T0时点(P<0.05),但低于常规组患者T1、T4时点(P<0.05)。两组患者HR在T1、T4时点均高于T0时点(P<0.05),试验组患者T2、T3、T4时点均低于常规组患者(P<0.05)。试验组患者血糖和血清皮质醇水平在各时点间均无差异(P>0.05),常规组患者血糖水平在T2、T3时点、血清皮质醇水平在T3时点均高于T0时点(P<0.05),试验组患者T3时点血糖水平低于常规组患者(P<0.05)。试验组患者术后苏醒时间短于常规组患者(P<0.01),拔管时呛咳反应评分低于常规组患者(P<0.01)。结论右美托咪定作为脊柱骨折手术全身麻醉维持药物替代丙泊酚,可在一定程度上抑制血糖和血清皮质醇升高,缩短患者术后苏醒时间,降低拔管时呛咳反应,保持血流动力学平稳,进而减轻应激反应。
Objective To observe the effect of dexmedetomidine using for general anesthesia maintain on perioperative stress response to the patients with spinal fracture surgery. Methods Sixty patients with elective surgery d spinal fracture were randomly divided into the test group （n= 30） and the conventional treatment group （n =30）. Immediately after induction of anesthesia, test group received 1μ g · kg -1 dose of dexmedetomidine by i. v. , then was pumped continuously by 0. 5-0. 7 μg · kg -1· h -1 to maintain. In conventional group, propofol was pumped by 4-6 mg · kg- 1· h- 1 as a control. Mean arterial pressure （MAP）, heart rate （HR） before 10 rain of induction （T0）, immediately after tracheal intubation （T1）, 60 rain after the beginning of surgery （T2）, surgery end （T3）, after extubation （T4） were monitored. Blood samples of 3 ml were extracted from fore arm for detecting blood glucose and serum cortisol levels at T0 ,T2 and T3. An additional dose of fentanyl, awakening time, and extubation cough reaction ratings were all recorded. Results In test group, MAP at T1 ,T4 were higher than at T0 （P〈0. 05）, and lower than those in conventional group （P^0. 05）. HR at T1, T4 were higher than T0 in both groups（P〈0. 05）, and from T2 to T4 in test group were lower than those in conventional group. Blood glucose and serum cortisol levels showed no differences at each time point in test group1 （P〉0.05）, blood glucose levels at T2, T3 and cortisol levels at T3 were higher than at To in conventional group （P^0.05）. Blood glucose at T3 in test group were lower than in conventional group （P〈0. 05）. Awakening time was shorter and extubation cough reaction ratings were lower in teal group than those in conventional group （P〈0. 01）. Conclusion Dexmedetomidine used in general anesthesia as a substitute to propoFol for the paients with spinal Fractnre surgery can inhibit to a certain extent the increasing of the blood glucose and serum cortisol, shorten the postoperative awakening time, decrease the extubation cough reaction ratings, keep the hemodynamic stability and then reduce the perioperative stress response.
出处
《国际骨科学杂志》
2012年第5期341-343,共3页
International Journal of Orthopaedics
关键词
右美托咪定
全身麻醉
应激反应
Dexmedetornidine
General anesthesia
Stress response
