%0 Journal Article
%T 右美托咪定对高血压控制不良患者全身麻醉气管插管期间血流动力学等的影响
%A 李家强
%A 　王晗　陈作雷
%J -
%D 2019
%R 10.13362/j.jpmed.201906011
%X 摘要 目的　研究右美托咪定对高血压控制不良患者全身麻醉（全麻）气管插管期间血流动力学的影响。 方法　选取我院合并原发性高血压但血压控制不良的手术患者60例（ASA Ⅱ～Ⅲ级），将患者分为试验组（D组）和对照组（C组）两组，每组各30例。D组患者全麻诱导前10 min泵注右美托咪定0.5 μg/kg（以生理盐水稀释至20 mL），C组患者泵注相同容量的生理盐水，10 min泵注结束后，立即行麻醉诱导并完成气管插管，两组患者麻醉诱导方案相同。观察2组患者泵药前（T0）、麻醉诱导前（T1）、麻醉诱导后（T2）及插管后1 min（T3）、3 min（T4）和5 min（T5）患者心率（HR）和平均动脉压（MAP）的变化，并计算HR与收缩压乘积（RPP）。上述各时间点采血并测量两组患者血浆肾上腺素（E）、去甲肾上腺素（NE）浓度的变化。 结果　C组患者HR、MAP、RPP以及血浆NE、E水平T3、T4时点较T0时点明显升高（F=6.77～12.03，P＜0.05）；而D组患者T3～T5时点HR、MAP以及RPP均明显低于T0时点（F=7.44～10.02，P＜0.05）；且D组患者T3时点仅血浆NE水平高于T0时点（F=6.77，P＜0.05）。D组患者T3～T5时点HR、MAP、RPP以及血浆NE、E的水平均明显低于C组（F=12.56～18.57，P＜0.05）。 结论　全麻诱导前给予右美托咪定可有效抑制高血压控制不良患者对气管插管操作引起的应激反应，使患者血流动力学更加平稳。<br>Abstract：Objective　To investigate the effect of dexmedetomidine on hemodynamics during tracheal intubation for general anesthesia in patients with poorly controlled hypertension. Methods　A total of 60 patients with poorly controlled primary hypertension (ASA grade Ⅱ-Ⅲ) who underwent surgery in our hospital were enrolled and divided into experimental group (group D) and control group (group C), with 30 patients in each group. The patients in group D were given the pumping of 0.5 μg/kg dexmedetomidine (diluted to 20 mL with normal saline) at 10 min before general anesthesia induction, and those in group C were given the pumping of an equal volume of normal saline. After the pumping ended 10 min later, anesthesia induction and tracheal intubation were performed immediately, with the same regimen for both groups. The two groups were observed in terms of heart rate (HR) and mean blood pressure (MAP) before pumping (T0), before anesthesia induction (T1), after anesthesia induction (T2), and at 1,3, and 5 min after tracheal intubation (T3, T4, and T5, respectively), and rate pressure product (RPP) was calculated. Blood samples were collected at the above time points to measure the changes in the plasm concentrations of ephedrine (E) and norepinephrine (NE). Results　For group C, HR, MAP, RPP, and plasma levels of NE and E at T3 and T4 were significantly higher than those at T0 (F=6.77-12.03,P<0.05); for group D, HR, MAP, and RPP at T3, T4, and T5 were significantly lower than those at T0 (F=7.44-10.02,P<0.05), and the plasma level of NE at T3 was significantly higher than that at T0 (F=6.77,P<0.05). Group D had significantly lower HR, MAP, RPP, and plasma concentrations of NE and E than group C at T3, T4, and T5 (F=12.56-18.57,P<0.05). Conclusion　Dexmedetomidine used before general anesthesia induction can significantly reduce stress response caused by tracheal intubation in patients with poorly controlled hypertension
%K 右美托咪定
%K 高血压
%K 麻醉
%K 全身
%K 气管插管
%K 血流动力学<br>Dexmedetomidine
%K Hypertension
%K Anesthesia
%K general
%K Endotracheal intubation
%K Hemodynamics
%U http://jpmed.qdu.edu.cn/CN/10.13362/j.jpmed.201906011