右美托咪啶联合布托啡诺对结肠癌患者术后拔管应激反应的影响
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摘要
目的研究静脉泵注右美托咪啶联合静脉推注布托啡诺在全麻患者术后拔管过程中对应激反应的影响。方法择期结肠癌手术患者120例,ASA分级1或2级,年龄35-65岁,随机分为:A、B、C、D 4组(n=30):对照组(A)、右美托咪啶组(B)、布托啡诺组(C)、布托啡诺联合右美托咪啶组(D)。A组静脉注射等量生理盐水,B组静脉泵注右美托咪啶,C组静脉注射布托啡诺,D组静脉泵注右美托咪啶同时静脉注射布托啡诺。并于手术结束时(T0),气管导管拔出前(T1),气管导管拔管后5min(T2),气管导管拔管后10min(T3)记录各时刻的心率(HR)和平均动脉压(MAP),以及测定血浆儿茶酚胺水平。评估拔管时患者的心率血压变化和呛咳程度。结果对照组、右美托咪啶组、布托啡诺组的T1时血浆儿茶酚胺水平升高,MAP和HR均升高;对照组T2、T3时各指标均升高;与对照组比较,右美托咪啶组、布托啡诺组和联合组T1、T2、T3各时刻儿茶酚胺水平及呛咳程度降低;与联合组比较,右美托咪定组和布托啡诺组T1时各指标水平及拔管时呛咳程度升高。结论右美托咪啶联合布托啡诺对全麻者术后拔管的应激有一定的抑制作用。
Objective To evaluate the effect of dexmedetomidine by intravenous pumping combined with butorphanol by intravenous injection on stress response during postoperative tracheal extubation. Methods 120 cases undergoing selective colon cancer surgery with ASA grade 1 or 2,were enrolled and randomly divided into 4 groups: control group(Group A),dexmedetomidine group(Group B),butorphanol group(Group C),butorphanol combined with dexmedetomidine group( Group D),30 in each; intravenous injection of normal saline was made to the cases in Group A while intravenous pumping of dexmedetomidine to cases in Group B,intravenous injection of butorphanol to cases in Group C and intravenous pumping of dexmedetomidine combined with intravenous injection of butorphanol to cases in Group D,the dosage applied kept the same; the mean arterial pressure( MAP) and heart rate( HR) of the cases in the 4 groups at the time point of T0( immediately after surgery),T1( just before extubation),T2(5 minutes after extubation) and T3(10 minutes after extubation) were recorded,and the levels of plasma catecholamine were detected;the changes of HR, blood pressure and cough in the cases were evaluated. Results The level of plasma catecholamine,MAP and HR at T1 increased in Group A,Group B and Group C,and they kept increasing at T2 and T3 in Group A; the level of plasma catecholamine and cough in Group B,Group C and Group D at T1,T2 and T3 were all lower than those in Group A( P<0. 05); the index at T1 and cough at extubation in Group B and Group C were higher and more severe than those in Group D( P<0. 05). Conclusions Dexmedetomidine combined with butorphanol can alleviate the stress response during postoperative extubation.
Objective To evaluate the effect of dexmedetomidine by intravenous pumping combined with butorphanol by intravenous injection on stress response during postoperative tracheal extubation. Methods 120 cases undergoing selective colon cancer surgery with ASA grade 1 or 2,were enrolled and randomly divided into 4 groups: control group(Group A),dexmedetomidine group(Group B),butorphanol group(Group C),butorphanol combined with dexmedetomidine group( Group D),30 in each; intravenous injection of normal saline was made to the cases in Group A while intravenous pumping of dexmedetomidine to cases in Group B,intravenous injection of butorphanol to cases in Group C and intravenous pumping of dexmedetomidine combined with intravenous injection of butorphanol to cases in Group D,the dosage applied kept the same; the mean arterial pressure( MAP) and heart rate( HR) of the cases in the 4 groups at the time point of T0( immediately after surgery),T1( just before extubation),T2(5 minutes after extubation) and T3(10 minutes after extubation) were recorded,and the levels of plasma catecholamine were detected;the changes of HR, blood pressure and cough in the cases were evaluated. Results The level of plasma catecholamine,MAP and HR at T1 increased in Group A,Group B and Group C,and they kept increasing at T2 and T3 in Group A; the level of plasma catecholamine and cough in Group B,Group C and Group D at T1,T2 and T3 were all lower than those in Group A( P<0. 05); the index at T1 and cough at extubation in Group B and Group C were higher and more severe than those in Group D( P<0. 05). Conclusions Dexmedetomidine combined with butorphanol can alleviate the stress response during postoperative extubation.
引文
[1]王萌,董铁立.右美托咪啶预防全身麻醉气管导管拔管时心血管反应观察[J].中华实用诊断与治疗杂志,2012,26(5):493-494.
[2]BINDU B,PASUPULETI S,GOWD U P,et al.Adouble blind,randomized,controlled trial to study the effect of dexmedetomidine on hemodynamic and recovery responses during tracheal extubation[J].J Anaesthesiol Clin Pharmacol,2013,29(2):162-167.
[3]YU F F,HE S Y.Effects of dexmedetomidine combined with hydrochloride on elderly anesthesia extubation response[J].Chin J Hosp Pharm,2013,33(5):414-416.
[4]Arar C,COLAK A,ALAGOL A,et al.The use of esmolol and magnesium to prevent haemodynamic responses to extubation after coronary artery grafting[J].Eur JAnaesthesiol,2007,24(10):826-831.
[5]KOVAC A L,MASIONGALE A.Comparison of nicardipine versu esmolol in attenuating the hemodynamic responses to anesthesia emergence and extubation[J].JCardiothorac Vasc Anesth,2007,21(1):45-50.
[6]蔡畅,郭建荣.右美托咪啶在临床应用中的研究进展[J].中国临床药理学与治疗学,2011,16(3):349-353.
[7]HALL J E,UHRICH T D,BARNEY J A,et al.Sedative,amnestic,and analgesic properties of small-dose dexmedetomidine infusions.Anesth Analg,2000,90(3):699-705.
[8]JALOWIECKI P,RUDNER R,GONCIARZ M,et al.Sole use of dexmedet omidine has limited utility for conscious sedation during outpatient colonoscopy.Anesthesiology,2005,103(2):269-273.
[9]YIN Q M,LJ H,SUN P.Hemodynamie effects of dexmedetomidine hydrochloride double-lumen endotracheai intubation[J].Asia-Pacific Tradit Med,2012,8(6):97-98.
[2]BINDU B,PASUPULETI S,GOWD U P,et al.Adouble blind,randomized,controlled trial to study the effect of dexmedetomidine on hemodynamic and recovery responses during tracheal extubation[J].J Anaesthesiol Clin Pharmacol,2013,29(2):162-167.
[3]YU F F,HE S Y.Effects of dexmedetomidine combined with hydrochloride on elderly anesthesia extubation response[J].Chin J Hosp Pharm,2013,33(5):414-416.
[4]Arar C,COLAK A,ALAGOL A,et al.The use of esmolol and magnesium to prevent haemodynamic responses to extubation after coronary artery grafting[J].Eur JAnaesthesiol,2007,24(10):826-831.
[5]KOVAC A L,MASIONGALE A.Comparison of nicardipine versu esmolol in attenuating the hemodynamic responses to anesthesia emergence and extubation[J].JCardiothorac Vasc Anesth,2007,21(1):45-50.
[6]蔡畅,郭建荣.右美托咪啶在临床应用中的研究进展[J].中国临床药理学与治疗学,2011,16(3):349-353.
[7]HALL J E,UHRICH T D,BARNEY J A,et al.Sedative,amnestic,and analgesic properties of small-dose dexmedetomidine infusions.Anesth Analg,2000,90(3):699-705.
[8]JALOWIECKI P,RUDNER R,GONCIARZ M,et al.Sole use of dexmedet omidine has limited utility for conscious sedation during outpatient colonoscopy.Anesthesiology,2005,103(2):269-273.
[9]YIN Q M,LJ H,SUN P.Hemodynamie effects of dexmedetomidine hydrochloride double-lumen endotracheai intubation[J].Asia-Pacific Tradit Med,2012,8(6):97-98.
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