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    盐酸右美托咪定对地氟醚引起的交感兴奋作用的影响

    The effects of dexmedetomidine on desflurane-mediated sympathoexcitation

    • 摘要: 目的 观察右美托咪定对地氟醚介导的交感兴奋作用的影响。方法 选择择期行胸外科手术患者60例(ASAⅠ—Ⅲ级),分为地氟醚组(C组)、右美托咪定复合地氟醚组(D组),各30例。C组入室后泵注0.1 ml/kg生理盐水,在麻醉诱导前10 min内泵完,后改为0.05 ml/(kg·h)的生理盐水维持。D组入室后泵注1.0 μg/kg右美托咪定,在麻醉诱导前10 min内泵完,后改为0.5 μg/(kg·h)的右美托咪定维持。采集给药前(T0)以及地氟醚呼气末浓度达1.0最低肺泡有效浓度(MAC)后1、2、3、4、5 min(T1、T2、T3、T4、T5)时2组患者平均动脉压(MAP)、心率(HR)、心率变异性(HRV)、血儿茶酚胺浓度值。结果 与T0时点相比,C组T1~T5时点的MAP、HR、低频/高频比值(LF/HF)、肾上腺素(E)、去甲肾上腺素(NE)值均升高(P<0.05);D组T1~T5时点的MAP、HR、LF/HF、E、NE值与T0时点相比差异无统计学意义(P>0.05);2组MAP、HR、LF/HF、E、NE值在T0时点差异无统计学意义(P>0.05),在T3、T4时点差异有统计学意义(P<0.05),2组HR、LF/HF、E、NE值在T5时点差异有统计学意义(P<0.05)。结论 右美托咪定可抑制地氟醚介导的交感兴奋作用。

       

      Abstract: Objective To investigate the effects of dexmedetomidine on desflurane-mediated sympathoexcitation. Methods A total of 60 patients undergoing elective thoracic surgery, ASAⅠ-Ⅲ, were randomly divided into two groups: desflurane group (Group C) and dexmedetomidine combined with desflurane group (Group D). Patients in Group C were treated with 0.1 ml/kg of normal saline within 10 min before induction of anesthesia, then the dose was changed to 0.05 ml/(kg·h) of normal saline. Patients in Group D were treated with 0.5 μg/kg dexmedetomidine within 10 min before induction of anesthesia, then the dose was changed to 0.5 μg/(kg·h) of dexmedetomidine. Mean arterial pressure (MAP), heart rate (HR), heart rate variability (HRV), levels of plasma norepinephrine (NE) and epinephrine (E) were recorded after entering the operating room (T0) and at 1 min, 2 min, 3 min, 4 min, 5 min (T1, T2, T3, T4, T5)after the concentration of desflurane reaching 1.0 minimum alveolar concentration (MAC). Results The MAP, HR, ratio of low frequency to high frequency (LF/HF), levels of plasma E and NE from T1 to T5 in Group C were higher than those of the T0 time point (P<0.05). The differences of MAP, HR, LF/HF, levels of plasma E and NE from T1 to T5 in Group D were not statistically significant (P>0.05). The differences of MAP, HR, LF/HF, levels of plasma E and NE at T0 time point were not statistically significant between Group C and Group D (P>0.05), while the differences were statistically significant between the two groups at T3 and T4 time points (P<0.05). The differences of HR, LF/HF, levels of plasma E and NE at T5 was statistically significant between the two groups (P<0.05). Conclusions Dexmedetomidine can inhibit desflurane-mediated sympathoexcitation, which is beneficial for maintaining perioperative hemodynamic stability and reducing perioperative complications.

       

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