右美托咪定经鼻腔给药对妇科全麻围拔管期应激反应的影响

Effects of dexmedetomidine by the intranasal route on the stress response during tracheal extubation after gynecological surgery

中文关键词: 右美托咪定  滴鼻  围拔管期  应激反应

英文关键词: Dexmedetomidine  Intranasal administration  Peri-extubation period  Stress response

中文摘要:

      
目的 观察不同剂量右美托咪定经鼻腔给药对妇科全麻围拔管期应激反应的影响, 并探讨最佳剂量。
方法 择期妇科手术患者80例, 随机分为对照组(C组)和不同剂量右美托咪定滴鼻组(D1组、D2组、D3组)。手术结束前30 min, D1、D2、D3组分别经鼻滴注右美托咪定0.6、1.2、1.8 μg/kg, C组用生理盐水滴鼻。记录给药前即刻(T1)、手术结束时(T2)、患者可唤醒时(T3)、拔管时(T4)、拔管后1 min(T5)、5 min(T6)、10 min(T7)的HR、MAP、SBP与HR乘积(RPP); 检测T1、T2、T4、T6时血浆去甲肾上腺素(NE)和皮质醇(Cor)浓度。记录患者术后恢复指标。
结果 与C组比较, T3～T5时D1组、T2～T7时D2、D3组MAP和RPP均明显降低，HR明显减慢(P<0.05);T4、T6时D1组、T2、T4和T6时D2、D3组血浆NE、Cor浓度明显降低(P<0.05)。C组、D1组和D2组唤醒时间、拔管时间及PACU留观时间均明显短于D3组（P<0.05）。
结论 手术结束前30 min给予右美托咪定1.2 μg/kg滴鼻可有效抑制全麻手术拔管期的应激反应，同时不影响术后恢复。

英文摘要:

      
Objective To explore the influence of dexmedetomidine for nasal administration by three different concentrations on the stress response in patients with general anaesthesia during the peri-extubation period of gynecological surgery and to explore the optimized dosage.
Methods Eighty patients undergoing general anaesthesia were randomly divided into four groups: control group (group C), and three different doses of intranasal dexmedetomidine, groups D1, D2, D3 receiving intranasal dexmedetomidine 0.6, 1.2 and 1.8 μg/kg 30 min before the end of the operation, respectively. Group C was given the same volume of saline. Heart rate (HR), mean arterial pressure (MAP) and rate-pressure-product (RPP) were recorded immediately after intranasal administration (T1), the end of the surgery (T2), recovery time (T3), extubation time (T4), 1 min after extubation (T5), 5 min after extubation (T6) and 10 min after extubation (T7). Blood samples were taken at T1, T2, T4 and T6 to detect the serum concentrations of norepinephrine (NE) and cortisol (Cor). Postoperative recovery outcomes were recorded.
Results Compared with group C, MAP, HR and RPP at T3-T5 in group D1 were reduced significantly (P<0.05). In addition, those were all decreased in groups D2 and D3 at T2-T7 (P<0.05). Compared with group C, the serum concentrations of NE and Cor at T4 and T6 in group D1, at T2, T4 and T6 in groups D2, D3 were decreased obviously (P<0.05). Awaken time, extubation time and PACU stay time were shortened significantly in groups C, D1 and D2 compared with group D3 (P<0.05).
Conclusion Intranasal administration of dexmedetomidine 30 min before the end of the operation could attenuate the extubation reaction and the adverse reaction of cardiovascular system during the peri-extubation period.