Effects of Dexmedetomidine combined with nicardipine on controlled hypotension and stress reaction in patients undergoing otological surgery
-
摘要:
目的 探讨右美托咪啶（Dex）复合尼卡地平(Nic)用于耳科手术患者控制性降压的效果及其对术中应激反应的影响。 方法选择60例ASAI-Ⅱ级行鼓室成形术的患者，随机分为2组（n=30）：尼卡地平组（N组），Dex+Nic组（DN组）。DN组麻醉诱导前15 min内静脉泵注Dex负荷剂量1 μg/kg，继之以0.5 μg/（kg·h）的速率输注至手术结束前30 min，术中维持BlS值40~49。N组手术开始时以2~3 μg/（kg·min）的速率输注Nic，使MAP降至并维持在60~65 mmHg，缝合伤口时停药。记录术中药物用量、出血量、输液量及手术时间、清醒时间、拔管时间。检测麻醉诱导前（T0），切皮前（T1），手术1 h（T2），术毕（T3）血浆皮质醇（Cor）及IL-6浓度。 结果与N组比较，DN组术中麻醉药和Nic用量降低，清醒时间及拔管时间缩短（P<0.05），与T0时比较，N组T2、T3时血浆Cor、血清IL-6浓度明显升高（P<0.05）。与N组比较，T2、T3时DN组血浆Cor、血清IL-6浓度均明显降低（P<0.05）。 结论右美托咪啶复合尼卡地平用于耳科手术患者，不仅能优化控制性降压的效果，而且能有效的抑制术中应激反应。 Abstract:ObjectiveTo observe the effects of dexmedetomidine combined with nicardipine on controlled hypotension and stress reaction in patients undergoing otological surgery． MethodsSixty ASA I or 1I patients，scheduled for Tympanoplasty surgery，were randomly allocated into 2 groups (n = 30 each)：nicardipine group (group N) and dexmedetomidine+nicardipine group(group DN)． A loading dose of dexmedetomidine 1ug/kg was injected intravenously 15 mins before induction of anesthesia, followed by infusion at 0.5 ug/kg/h until 30 mins before the end of operation in group DN. BIS value was maintained at 40-49 during operation．Group N was performed with iv infusion of nicardipine at a rate of 2-3ug/kg/min, MAP was reduced to 60-65 mmHg，then the infusion rate was adjusted to maintain MAP at this level，and nicardipine infusion was stopped while closing the skin. The amount of anesthetics and nicardipine consumed, blood loss，volume of fluid infused during operation and the operation time，emergence time and extubation time were recorded. The levels of serum IL-6, plasma cortisol were detected before the induction of anesthesia(T0), before incision(T1), l h after the beginning of the operation(T2), at the end of the operation(T3). ResultsCompared with group N, the amount of anesthetics and nicardipine consumed was significantly decreased，the emergence time and extubation time were significantly shortened(P < 0.05), and no significant change in the volume of fluid infused and blood loss was found in group DN (P > 0.05). Compared with T0,at T2, T3, serum IL-6 and plasma cortisol increased in group N (P < 0.05). Compared with group N, at T2，T3, serum IL-6 and plasma cortisol decreased in group DN (P < 0.05). ConclusionDexmedetomidine combined with nicardipine not only can improve the efficacy of nicardipine for controlled hypotension, but also can reduce stress reaction when used in patients undergoing otological surgery． -
Key words:
- dexmedetomidine /
- nicardipine /
- controlled Hypotension /
- stress reaction
-
表 1 两组一般资料比较(n=30)
组别 年龄（岁） 体质量指数(kg/m2) 性别(例，男/女) 手术时间(min) DN组 35.1±4.8 23.5±4.1 14/16 120.4±5.8 N组 34.3±5.2 22.9±4.9 15/15 119.7+6.9 t/x2 0.734 0.770 0.127 0.362 P >0.05 >0.05 >0.05 >0.05 
下载: 导出CSV
表 2 两组患者术中情况比较(n=30)
组别 N组 DN组 麻醉时间(min) 135.7±6.5 139.4±5.6 尼卡地平总剂量(mg) 6.3±1.5 3.6±1.4* 丙泊酚总剂量(mg) 250.3±7.5 1050.4±3.6* 瑞芬太尼总剂量(mg) 2.1±0.4 1.5±0.3* 拔管时间(min) 20.6±4.2 14.2±3.3* 苏醒时间(min) 21.4±3.7 15.3±4.5* 输液量(mL) 1010±123 1180±130 出血量(mL) 22±5 19±7 *组间比较P<0.05 具有统计学意义.
下载: 导出CSV
表 3 两组患者围术期血浆Cor 及血清IL-6 浓度(n=30)
指标 组别 T0 T1 T2 T3 Cor DN组 85.23±18.56 100.71±16.63 94.40±15.68b 90.67±16.87b pg/L N组 82.56±17.43 105.78±19.46 120.23±17.43a 124.45±18.21a IL-6 DN组 0.21±0.15 0.20±0.13 0.23±0.09b 0.24±0.14b ng/mL N组 0.23±0.11 0.22±0.13 0.35±0.12a 0.40±0.18a 与T0时比较, aP<0.05; 与N组比较bP<0.05.
下载: 导出CSV
-
[1] 汪晨, 熊利泽, 张英民. 控制性降压全麻在电子耳蜗植入术中的应用[J]. 临床麻醉学杂志, 2002, 18(5): 277-8. [2] Talke P, Chen R, Thomas B, et al. The hemodynamic and adrenergic effects of perioperative dexmedetomidine infusion after vascular surgery[J]. Anesth Analg, 2000, 90(4): 834-9. [3] Wijeysundera DN, Nail JS, Beattie WS. Aplha-2 adrenergic agonists to prevent perioperative cardiovascular complications:a meta-analysis[J]. Am J Med, 2003, 114(9): 742-52. [4] Peden CJ, Cloote AH, Stratford N, et al. The effect of intravenous dexmedetomidine premedication on the dose requirement of propofol to induce loss of consciousness in patients receiving alfentanil [J]. Anaesthesia, 2001, 56(5): 408-13. [5] 王天龙, 姜燕, 杨拔贤. 尼卡地平与低剂量艾司洛尔联合控制性降压对血液儿茶酚胺、β2-微球蛋白和血乳酸的影响[J]. 中华麻醉学杂志,2002, 22(9): 521-4. [6] Jung HS, Joo JD, Jeon YS, et al. Comparison of an intraoperativeinfusion of dexmedetomidine or remifentanil on perioperative haemo-dynamics,hypnosis and sedation,and postoperative pain contrl [J]. J Int Med Res, 2011, 39(5): 1890-9. [7] 尤克强, 陈莺. 右美托咪啶用于行神经外科手术的高血压患者全身麻醉拔管期的有效性和安全性[J]. 上海医学, 2010, 33(12): 1103-5. [8] Desborough JP. The stress response to trauma and surgery[J]. Br J Anaesth, 2000, 85(1): 109-17. [9] Bone. Toward a theory regarding the pathogenesis of the systemic inflammatory response syndrome：what we do and do not know about eytokine regulation[J]. Crit Care Med, 1996, 24(1): 16-72. [10] 徐枫. 杨承样, 邓硕曾. 右美托咪啶在围术期临床应用的研究进展[J]. 国际麻醉学与复苏杂志, 2011, 32(3): 336-40. [11] 杨小虎. 右美托咪啶用于行神经外科手术的高血压患者全身麻醉拔管期的有效性和安全性[J]. 上海医学, 2011, 34(10): 747-9. -
点击查看大图
表(3)
计量
- 文章访问数: 475
- HTML全文浏览量: 205
- PDF下载量: 1
- 被引次数: 0
