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    不同剂量盐酸右美托咪定对骨科全麻手术病人升压效应的影响

    Effect of different doses of dexmedetomidine hydrochloride on the pressor effect in orthopedic general anesthesia patients

      摘要
    • 摘要:
      目的探讨不同剂量盐酸右美托咪定对骨科全麻手术病人升压效应的影响。
      方法120例手术病人，ASAⅠ级或Ⅱ级，根据随机数字表法分为3组：小剂量组（Dex1组）40例，于麻醉诱导前泵注0.5 μg/kg盐酸右美托咪定，大剂量组（Dex2组）40例，泵注0.8 μg/kg盐酸右美托咪定，对照组（C组）40例，泵注等量0.9%氯化钠溶液，所有病人置入喉罩5 min后均静脉注射0.1 mg/kg麻黄碱。比较3组病人入室后（T1）、麻醉诱导前（T2）、麻醉诱导后1min（T3）、置入喉罩（T4）、注射麻黄碱后即刻（T5）的心率（HR）、收缩压（SBP）和舒张压（DBP）；并比较3组病人注射麻黄碱10 min内HR、血压到达最大值的时间（MtHR和MtBP）以及HR、SBP、DBP的最大值与T5时刻的差值（ΔHR、ΔDBP和ΔSBP）。
      结果Dex1组、Dex2组T2、T3、T4、T5时刻HR、SBP和DBP均低于C组（P < 0.01），Dex2组T2、T3、T4、T5时刻SBP和DBP均低于Dex1组（P < 0.01），Dex1组、Dex2组T2、T3、T4、T5时刻HR差异均无统计学意义（P>0.05）；Dex1组、Dex2组ΔHR、ΔDBP、ΔSBP均明显高于C组，MtHR和MtBP均明显低于C组（P < 0.01）；Dex2组ΔHR、ΔDBP、ΔSBP均明显高于Dex1组（P < 0.01）；Dex1组、Dex2组MtHR和MtBP差异均无统计学意义（P>0.05）。
      结论盐酸右美托咪定能够增强骨科全麻手术病人升压效果，并加快见效时间，且剂量为0.8 μg/kg时的升压效果明显优于0.5 μg/kg。

       

      Abstract:
      ObjectiveTo investigate the effects of different doses of dexmedetomidine hydrochloride on the pressor effect in orthopedic general anesthesia patients.
      MethodsOne hundred and twenty surgical patients with ASA grade Ⅰ or Ⅱ were divided into the small dose group(Dex1 group, n=40), large dose group(Dex2 group, n=40) and control group(group C, n=40) according to random number table method.The Dex1 group, Dex2 group and control group were injected with 0.5 μg/kg of dexmedetomidine hydrochloride before anesthesia induction, 0.8 μg/kg of dexmedetomidine hydrochloride and equal amount of 0.9% sodium chloride solution, respectively.All patients were intravenously injected with 0.1mg/kg of ephedrine after 5 min of Laryngeal-mask-airway(LMA).The heart rate(HR), systolic blood pressure(SBP) and diastolic blood pressure (DBP) were compared among three groups after entering the operating room(T1), before anesthesia induction (T2), after 1min of anesthesia induction(T3), LMA(T4), and immediately after injection of ephedrine(T5).The time of the maximum HR and blood pressure(MtHR and MtBP) after 10 min of injection of ephedrine, and the differences value of the maximum value of HR, SBP and DBP to the value at T5(ΔHR, ΔDBP and ΔSBP) were compared among three groups.
      ResultsThe HR, SBP and DBP in Dex1 group and Dex2 group were lower than those in group C at T2, T3, T4 and T5(P < 0.01), the SBP and DBP in Dex2 group were lower than those in Dex1 group at T2, T3, T4 and T5(P < 0.01), and the differences of HR between Dex1 group and Dex2 group at T2, T3, T4 and T5 were not statistically significant(P>0.05).The ΔHR, ΔDBP and ΔSBP in Dex1 group and Dex2 group were significantly higher than those in group C(P < 0.01), and the MtHR and MtBP in Dex1 group and Dex2 group were significantly lower than those in group C(P < 0.01).The ΔHR, ΔDBP and ΔSBP in Dex2 group were lower than those in Dex1 group(P < 0.01), and there was no statistical significance in the MtHR and MtBP between the Dex1 group and Dex2 group(P>0.05).
      ConclusionsDexmedetomidine hydrochloride can enhance the the pressor effect and accelerate the response time, and the pressor effect of 0.8 μg/kg is significantly better than that of 0.5 μg/kg in orthopedic general anesthesia patients.

       

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