| 摘要: |
| 目的（Objective） 探讨右美托咪定对于腹腔镜完全腹膜外疝修补术患者在围手术期应激及苏醒质量的影响。方法（Methods） 将择期行腹腔镜下完全腹膜外腹股沟疝修补术患者40例，随机分为2组，右美托咪定组D组和对照组C组（生理盐水组），每组20例，两组患者均采用气管插管静脉麻醉，D组在麻醉诱导前15分钟均予负荷剂量盐酸右美托咪定0.2ug/kg，术中右美托咪定分别以0.4ug·kg-1·h-1维持静脉泵注，直至手术结束前20分钟结束泵注，对照组同样予相同方式泵入同等量的生理盐水，麻醉维持均采用丙泊酚和瑞芬太尼静脉泵注，维持脑电双频指数（BIS）40~60，记录麻醉诱导前15分钟T0、气管插管后1分钟T1、手术开始时T2、气管插管拔管时T3及术后30分钟T4的平均动脉压（MAP）、心率（HR），抽取外周静脉血，检测这几个时间点的肾上腺素（E）、去甲肾上腺素(NE)水平和血糖值（Glu）。记录心动过缓、心动过速、高血压、拔管后躁动及呕心呕吐等不良事件发生情况。结果（Results）D组患者在T1、T2、T3、T4的肾上腺素（E）、血糖（Glu）较T0时明显升高，在T1、T2、T3的去甲肾上腺素（NE）较T0也明显升高（P<0.05）；C组患者在T1、T2、T3、T4时肾上腺素（E）、去甲肾上腺素（NE）、血糖（Glu）较T0均明显升高（P<0.05）；与C组相比较，D组在T1、T2、T3、T4各时间的肾上腺素（E）、去甲肾上腺素（NE）和血糖（Glu）均明显降低（P<0.05）。不良反应对比，D组的心动过速、高血压、、拔管后躁动、恶心呕吐发生例数明显少于C组（P<0.05），同时心动过缓发生率高于C组（P<0.05）。结论（Conclusion）右美托咪定是一种高选择性ɑ2肾上腺素能受体激动剂，具有中枢抗交感神经作用，有明确的镇静，镇痛作用，可以抑制腹腔镜完全腹膜外疝修补术中的应激反应，保证手术安全性，同时能提高复苏质量。 |
| 关键词: 右美托咪定；腹腔镜完全腹膜外疝修补术；应激反应；肾上腺素；去甲肾上腺素；血糖 苏醒质量 |
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| Effect of dexmedetomidine on the stress and recovery in laparoscopic totally extraperitioneal prosthesis under general anesthesia |
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宋晓乾
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Taicang Hospital of Traditional Chinese Medicine
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| Abstract: |
| 【Abstract】 Objective: To investigate the effect of dexmedetomidine on perioperative stress and recovery in patients undergoing laparoscopic totally extraperitoneal prosthesis. Methods: A total of 40 patients undergoing elective laparoscopic totally extraperitoneal inguinal prosthesis were randomly enrolled into 2 groups, dexmedetomidine group D group and control group C group (saline group), 20 cases in each group. The patients in both groups were treated with tracheal intubation and intravenous anesthesia. In group D, the dose of dexmedetomidine hydrochloride was 0.2ug/kg 15 minutes before the induction of anesthesia. The intraoperative dexmedetomidine was 0.4ug·kg-1·h-1 with continuous intravenous pumping until the last 20 minutes of the operation, the control group was given normal saline at the same amount together with anesthesia maintenance by propofol and remifentanil, maintaining an EEG Bispectral index (BIS) 40~60. We recorded mean artery pressure(MAP), Heart rate (HR) and measured the levels of epinephrine (E), norepinephrine (NE) levels and blood glucose (Glu) from peripheral blood at the following time points, including baseline, 15 minutes before anesthesia induction(T0), 1 minute after tracheal intubation(T1), at the beginning of surgery(T2), at tracheal intubation(T3), and at 30 minutes postoperatively(T4).We also reported here for those cases with bradycardia, tachycardia, hypertension, agitation after extubation, and vomiting .Results: Patients in group D had significantly higher epinephrine (E) and blood glucose (Glu) at T1, T2, T3, and T4, and norepinephrine (NE) at T1, T2, and T3 compare to baseline, which are statistically significant (P<0.05); in group C, T1, T2, T3, T4 were significantly higher in epinephrine (E), norepinephrine (NE), and blood glucose (Glu) than T0 (P<0.05). Compared with group C, adrenaline (E), norepinephrine (NE) and blood glucose (Glu) were significantly lower in group D at T1, T2, T3, and T4(P<0.05). Regarding the adverse reactions, the incidence of tachycardia, hypertension, post-tubing agitation, nausea and vomiting in group D was significantly lower than that in group C (P<0.05), and the incidence of bradycardia was higher than that in group C (P<0.05).Conclusion: Dexmedetomidine is a highly selective ɑ2 adrenergic receptor agonist with central anti-sympathetic effects, clear sedative and analgesic effects, and can inhibit laparoscopic totally extraperitoneal hernia repair. The stress response in the operation ensures the safety and improves the recovery of the operation. |
| Key words: dexmedetomidine totally extraperitioneal prosthesis stress response Epinephrine Norepinephrine Glucose Recovery quality |
