Objective To study the effects of different doses of dexemedetomidine on perioperative stress response in elderly patients undergoing laparoscopic gastrointestinal surgery.Methods Eighty ASA grade Ⅰ or Ⅱ elderly patients,aged≥65 years,falling into ASA Ⅰ or Ⅱ,undergoing laparoscopic gastrointestinal surgery,were randomly divided into four groups:group D1,D2,D3 and C,twenty cases in each.Dexmedetomidine was administrated with a loading dose of 0.5 μg/kg which was infused intravenously over 10 minutes before induction,and was infused intrave nously with a continuous dose of 0.2μg·kg-1 ·h-1,0.5μg·kg-1 ·h-1 and 0.8μg· kg-1 ·h-1 during operation respectively in group D1,D2,D3.In group C,patients were given 7 ml saline which was infused intravenously over 10 minutes before induction,and was infused with a continuous dose of 10 ml/h saline during operation.HR,SBP and DBP were recorded at before infusion (T0),immediately after intubation (T1),5 minutes after pneumoperitoneum (T2),1 hour after pneumoperitoneum (T3),immediately after extubation (T4),10 minutes after extubation (T5).The time of operation and the time of extubation were also recorded.Concentrations of Glu,Cor,E and NE were measured at T0,T1,T3,T5.Results The dosage of remifentanil in group D1,group D2 and group D3 was significantly lower than that in group C,and in group D2 and D3 was significantly lower than that in group D1 (P＜0.05).During T2-T5,HR of group D2 and group D3 was significantly slower than that of group C and group D1 (P＜0.05),and SBP of group D2 and group D3 was obviously lower than that of group C (P＜0.05),respectively.Compared with T0,HR of group C was significantly faster than that at T1-T5 (P＜0.05).Compared with group C,the concentrations of Glu,Cor,E and NE in group D2 and group D3 were extremely decreased (P＜0.05) at T3 and T5,and the concentrations of Cor and NE were obviously lower at T1 (P＜0.05).The concentrations of Cor and NE in group D2 and group D3 were remarkably lower than those in group D1 at T3 and T5 (P＜0.05).The extubation time of group D3 was apparently longer than that of group C (P ＜ 0.05).Conclusion Compared with continuous dose of 0.2 μg·kg-1 ·h-1 and 0.8 μg·kg-1 ·h-1 dexmedetomidine,dexmedetomidine infused intravenously at 0.5 μg· kg-1 · h-1 can more effectively inhibit perioperative stress responses of elderly patients undergoing laparoscopic gastrointestinal surgery,and maintain hemodynamic stability.%目的 观察不同剂量右美托咪定对腹腔镜下胃肠手术老年患者围术期应激反应的影响.方法 择期行腹腔镜下胃肠手术老年患者80例,性别不限,年龄≥65岁,ASA Ⅰ或Ⅱ级.随机分为四组,每组20例.所有患者均采用全凭静脉麻醉.D1、D2组和D3组麻醉诱导前10 min静脉泵注右美托咪定0.5μg/kg,插管后分别静脉泵注右美托咪定0.2、0.5、0.8μg· kg-1 ·h-1至术毕前30 min;C组麻醉诱导前10 min静脉泵注7 ml生理盐水,插管后静脉泵注生理盐水10 ml/h至术毕前30 min.记录术中麻醉药物用量,记录给药前(T0)、气管插管后即刻(T1)、气腹后5 min(T2)、气腹后60 min(T3)、拔管后即刻(T4)和拔管后10 min(T5)的HR、SBP、DBP,分别于T0、T1、T3、Ts时抽取桡动脉血,测定Glu、Cor、E和NE浓度.结果 D1组、D2组和D3组术中瑞芬太尼的用量明显少于C组,且D2组和D3组明显少于D1组(P＜0.05).与T0时比较,T1～T5时C组HR明显增快(P＜0.05).T2～T5时,D2组和D3组的HR明显慢于C组和D1组,SBP明显低于C组(P＜0.05);T1时D2组和D3组Cor和NE浓度也明显低于C组(P＜0.05).T3和T5时,D2组和D3组Glu、Cor、E和NE浓度明显低于C组,D2组和D3组Cor和NE浓度明显低于D1组(P＜0.05).结论 与0.2和0.8 μg·kg-1·h-1右美托咪定静脉泵注维持比较,0.5 μg·kg-1 ·h-1能更有效抑制腹腔镜下胃肠手术老年患者围术期应激反应.
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