预注右美托咪定对依托咪酯诱导全麻气管插管安全性研究

中国临床药理学与治疗学 ›› 2014, Vol. 19 ›› Issue (1): 48-53.

预注右美托咪定对依托咪酯诱导全麻气管插管安全性研究

赵刚, 蔡建明, 俞米林, 路牧

浙江省诸暨市人民医院麻醉科,诸暨 311800, 浙江

收稿日期:2013-02-04 修回日期:2013-08-11 出版日期:2014-01-27 发布日期:2014-02-12
作者简介:赵刚,男,本科,副主任医师,研究方向:临床麻醉与镇痛。Tel: 0575-87182326 E-mail: zg991337@126.com

Effects of pre-injection of Dexmedetomidine on safety during Etomidate induction of general anesthesia

ZHAO Gang, CAI Jian-ming, YU Mi-ling, LU Mu

Department of Anesthesiology, Zhuji People's Hospital of Zhejiang Province, Zhuji 311800, Zhejiang, China

Received:2013-02-04 Revised:2013-08-11 Online:2014-01-27 Published:2014-02-12

摘要/Abstract

摘要： 目的: 观察预注右美托咪定对依托咪酯诱导插管的患者安全性情况。方法: 择期头颈部手术患者80例,随机分成四组:依托咪酯复合右美托咪定组(A组)、丙泊酚复合右美托咪定组(B组)、依托咪酯组(C组)、丙泊酚组(D组),每组20例。记录四组患者在入室后麻醉前基础值(T₀)、给予右美托咪定开始 1 min(T₁)、输注右美托咪定 10 min(T₂)、麻醉诱导后 3 min 为(T₃)、插管即刻(T₄)、插管后 1 min(T₅)、插管后 3 min(T₆)、插管后 10 min(T₇)的SBP、DBP、脑电双频指数(BIS)、心率(HR),记录T₀、T₂两个时点血氧饱和度(SpO₂)值、Ramsay评分。结果: T₂时点与T₀时点比较,A、B组HR下降,并低于C、D组(P<0.01),但对血压并未产生影响(P>0.05);T₃时点跟T₀时点比较,A、B、C三组SBP下降(P<0.01),A、C组DBP下降(P<0.01),B 组DBP下降(P<0.05), T₄时点A组SBP高于B组(P<0.01),A组DBP高于B组(P<0.05);T₅、T₆、T₇时点A、B两组血压、HR比较无统计学差异(P>0.05)。A、B两组SpO₂值T₂时点低于T₀时点(P<0.01),T₂时点Ramsay评分,A、B两组高于C组(P<0.05)。A、B组BIS值T₂时点低于T₀(P<0.01),T₃~T₇时点三组均低于T₀(P<0.01),T₅时点C、D组BIS值高于A、B组(P<0.05)。结论: 预注右美托咪定可以降低依托咪酯诱导全麻气管插管的心血管反应,保留较丙泊酚复合右美托咪定更好的循环调节功能,其抑制插管心血管反应效能和丙泊酚相似。

关键词: 右美托咪定, 丙泊酚, 依托咪酯, 气管插管, 血流动力学

Abstract: AIM: To observe the effect pre-injection of Dexmedetomidine on safety during Etomidate induction of general anesthesia.METHODS: Eighty patients with ASA I-Ⅱ scheduled for head or neck surgery were randomly assigned to 4 groups:A(n=20),B(n=20),C(n=20),D(n=20).Group A,B received Dexmedetomidine 1 μg/kg intravenous injection and the whole dose was given within 10 minutes.Group C,D received equal volume of normal saline as Group A intravenously without Dex. Anesthesia was induced with Sufentanil 0.5 μg/kg,Atracurium 0.6 mg/kg and Etomidate 0.2 mg/kg in group A,C .Anesthesia was induced with propofol 1.5 mg/kg in group B,D.All other induction and maintenance drugs were same for two groups.HR,SBP,DBP,BIS were recorded at the time points of pre-administration of Dexmedetomidine (T₀,base value),l min after administration(T₁),10 min after administration(T₂),pre-intubation(T₃),intubation(T₄),l min after intubation(T₅),3 min after intubation(T₆),10 min after intubation(T₇).SpO₂, Ramesay scale were recorded at the time points of T₀ and T₂.RESULTS: After Dexmedetomidine was given,SpO₂ decreased (P<0.01) and Ramesay scale increased in group A and group B(P<0.01).There was no obvious change in group C,D(P>0.05). Compared with the base value,SBP and DBP of each group was decreased at T₃ (P<0.05); compared with the base value,SBP,DBP,and HR of Group C increased obviously with intubation (P<0.05),and HR remained higher than group A and group B after intubation(P<0.01);Compared with the group C,SBP,DBP,and HR of group A and group B were lower at T₄ and T₅(P<0.05).Compared with the group B,SBP and NBP of group A were higher at T₄ (P<0.05). SBP,DBP,and HR at T₅-T₇ were not signficantly different between group A and group B(P>0.05). Compared with the base value,BIS of group A and group B were decreased at T₂ (P<0.01), BIS of group A,B,D were lower than group C at T₅ (P<0.05).CONCLUSION: A single dose of Dexmedetomidine can effectively reduce cardiovascular responses to tracheal intubation during induction of general anaesthesia. Etomidate remain better instantaneous cardiovascular response to laryngoscope and intubation than Propofol and is similar with Propofol in inhibiting the stress response after tracheal intubation during general anaesthesia.

Key words: Dexmedetomidine, Propofol, Etomidate, Tracheal intubation, Hemodynamic

中图分类号:

R614

赵刚, 蔡建明, 俞米林, 路牧. 预注右美托咪定对依托咪酯诱导全麻气管插管安全性研究[J]. 中国临床药理学与治疗学, 2014, 19(1): 48-53.

ZHAO Gang, CAI Jian-ming, YU Mi-ling, LU Mu. Effects of pre-injection of Dexmedetomidine on safety during Etomidate induction of general anesthesia[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2014, 19(1): 48-53.

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