右美托咪定对老年高血压患者双腔支气管插管时血流动力学的影响

摘要

Objective To investigate the influence of dexmedetomidine on hemodynamics during intubation of double lumen endobronchial tube in elderly patients with hypertension.Methods Sixty elderly patients with hypertension who underwent thoracotomy operation from May 2014 to March 2015 were randomly divided into control group (30 cases) and observation group (30 cases).Dexmedetomidine (0.5 μg/kg,4 mg/L) and the 0.9％ sodium chloride (the same dose) were respectively intravenously infused within 20 min before anesthesia induction in observation group and control group.The mean arterial pressure (MAP),heart rate (HR),bispectral index (BIS) immediately after admission (T1),10 and 20 min after infusion of dexmedetomidine or 0.9％ sodium chloride (T2,T3),before intubation (T4),intubation (T5),1,3,5 min after intubation (T6,T7,T8) were recorded;the concentration of epinephrine (E) and norepinephrine (NE) in blood were monitored at T4-T8;the usage of propofol during anesthesia induction was recorded.Results At T1,T2,the MAP and HR were not significantly different between groups (P ＞ 0.05).The MAP and HR at T3,T5-T8,the BIS at T3 in observation group were significantly lower than those in control group [MAP:(80 ± 14) mmHg vs (98 ± 15) mmHg,(96 ±18) mmHgvs (116±14) mmHg,(110±10) mmHg vs (130±12) mmHg,(104±11) mmHg vs (126±10) mmHg,(100 ± 12) mmHg vs (120 ± 14) mmHg;HR:(65 ± 10) times/min vs (77 ± 14) times/min,(68 ± 10) times/min vs (88 ± 12) times/min,(80 ± 11) times/min vs (98 ± 14) times/min,(77 ± 16) times/min vs (90 ± 13) times/min,(70 ± 11) times/min vs (88 ± 15) times/min;BIS:(80 ± 6) vs (93 ± 7)] (P ＜ 0.05).At T5-T8,the levels of E and NE in observation group were significantly lower than those in control group [E:(40±10) nmol/Lvs (51 ±12) nmol/L,(50±11) nmol/Lvs (64±9) nmol/L,(49±11) nmol/Lvs (60 ± 10) nmol/L,(44 ± 10) nmol/L vs (55 ± 11) nmol/L;NE:(101 ± 14) nmol/L vs (136 ± 13) nmol/L,(123 ± 17) nmol/L vs (158 ± 15) nmol/L,(109 ± 16) nmol/L vs (147 ± 14) nmol/L,(102 ± 18) nmol/L vs (116 ± 19) nmol/L] (P ＜ 0.05).The usage of propofol in observation group were significantly less than that in control group [(84 ±26)mg vs (108 ±30)mg] (P＜0.05).Conclusion Use of 0.5 μg/kg dexmedetomidine can reduce stress reaction to intubation of double lumen endobronchial tube and stabilize the hemodynamics inelderly patients with hypertension.%目的 观察右美托咪定对老年高血压患者双腔支气管插管时血流动力学的影响.方法 选择2014年5月至2015年3月首都医科大学附属北京胸科医院拟行开胸手术老年高血压患者60例,按照随机数字表法分成对照组和右美托咪定组,各30例.麻醉诱导前,有美托咪定组静脉泵注0.5 μg/kg右美托咪定20 min,浓度4 mg/L;对照组泵注同等剂量的0.9％氯化钠注射液.记录入室后即刻(T1)、右美托咪定泵注10 min(T2)、右美托咪定泵注20 min(T3)、插管前(T4)、插管即刻(T5)、插管后1 min(T6)、插管后3min(T7)、插管后5 min(T8)各时点心率、平均动脉压(MAP)及脑电双频指数(BIS).应用放射免疫法测定T4 ～ T8时点动脉血中肾上腺素、去甲肾上腺素的水平.记录麻醉诱导时丙泊酚用量.结果 2组T1、T2时点MAP、心率差异无统计学意义(P＞0.05).右美托咪定组T3、T5 ～ T8时点MAP、心率以及T3时点BIS明显低于对照组[MAP:(80±14) mmHg(1 mmHg =0.133 kPa)比(98±15) mmHg、(96±18) mmHg比(116±14) mmHg、(110±10) mm Hg比(130±12) mmHg、(104±11) mmHg比(126±10) mmHg、(100±12) mmHg比(120±14) mmHg;心率:(65±10)次/min比(77±14)次/min、(68±10)次/min比(88±12)次/min、(80±11)次/min比(98±14)次/min、(77±16)次/min比(90±13)次/min、(70±11)次/min比(88±15)次/min;BIS:(80±6)比(93±7)],差异均有统计学意义(均P＜0.05).右美托咪定组肾上腺素、去甲肾上腺素在T5～ T8时点均明显低于对照组[肾上腺素:(40±10) nmol/L比(51±12) nmol/L、(50±11) nmol/L比(64±9) nmol/L、(49±11) nmol/L比(60±10) nmol/L、(44±10) nmol/L比(55±11) nmol/L,去甲肾上腺素:(101±14)nmol/L比(136 ± 13) nmol/L、(123±17) nmol/L比(158±15) nmol/L、(109±16) nmol/L比(147±14) nmol/L、(102±18) nmol/L比(116±19) nmol/L],差异均有统计学意义(均P＜0.05).右美托咪定组丙泊酚用量明显少于对照组[(84 ±26)mg比(108±30) mg],差异有统计学意义(P＜0.05).结论 麻醉诱导前应用0.5 μg/kg右美托咪定,可有效抑制老年高血压患者双腔支气管插管时应激反应,保持血流动力学稳定.