右美托咪定预防全身麻醉苏醒期应激反应临床研究.docVIP

精品论文 参考文献 右美托咪定预防全身麻醉苏醒期应激反应临床研究 朱月皓 刘文值 钟海蓉 韩洪波 　　四川省攀枝花市中西医结合医院麻醉科 四川攀枝花 617000 　　摘要：目的：观察右美托咪定对全身麻醉下腹腔镜切除胆囊患者苏醒期气管拔管前后应激反应的影响。方法：选择拟行全身麻醉下腹腔镜胆囊切除术患者50例，ASA I或Ⅱ级，随机分为对照组（N组）和右美托咪定组（D组），每组各25例，右美托咪定组术前静脉微量泵给予负荷量右美托咪定0.8ug/kg与生理盐水配置20ml，推注时间15分钟，维持剂量为0.2ug/（kg.h），对照组术前静脉微量泵给予0.9%生理盐水20ml，推注时间15分钟，均在手术结束前30分钟停止。芬太尼-异丙酚-琥珀胆碱诱导，瑞芬太尼-异丙酚-维库溴铵维持，术毕呼吸恢复后拔管。观察并记录患者入手术室T0，拔管前T1，拔管后1分钟T2，拔管后5分钟T3，拔管后10分钟T4的血压、心率的变化，并在各时段点抽取静脉血测血浆皮质醇和去甲肾上腺素的浓度。结果：右美托咪定组血压、心率、血浆皮质醇、去甲肾上腺素在拔管后1min、拔管后5min、拔管后10min无明显波动，无统计学意义。对照组血压、心率、血浆皮质醇、去甲肾上腺素较右美托咪定组在拔管前1min、拔管后1min、拔管后5min、拔管后10min均有增高（Plt;0.05）。结论：全麻期间持续应用盐酸右美托咪定能有效维持全麻苏醒期血流动力学的稳定，降低患者全麻苏醒期血浆皮质醇和去甲肾上腺素水平，降低全身麻醉苏醒期应激反应。 　　关键词：右美托咪定；全麻苏醒期；应激反应 　　Abstract：Objective：To observe the effects of dexmedetomidine anesthesia of laparoscopic cholecystectomy in patients with tracheal extubation after stress response of the body.Methods：under general anesthesia undergoing laparoscopic cholecystectomy in 50 patients，ASA I or II，were randomly divided into control group（group N）and dexmedetomidine group（D group），25 cases in each group，dexmedetomidine group of preoperative intravenous micro pump with loading dose of dexmedetomidine 0.8ug/kg and saline 20ml configuration，injection time of 15 minutes，a maintenance dose of 0.2ug/（kg.h），the control group of preoperative intravenous micro pump with 0.9% normal saline 20ml，injection time of 15 minutes，in the stop 30 minutes before the end of operation. Fentanyl，propofol and succinylcholine induced byremifentanil propofol，vecuronium bromide，postoperative respiratory recovery after extubation. Observe and record the patients into the operation room T0 before extubation，T1after extubation，T2 after extubation in 1 minutes，5 minutes and 10 minutes T4 T3，changesof blood pressure，heart rate after extubation，and venous blood samples in each period ofmeasurement of plasma cortisol and norepinephrine concentration. Results：Dexmedetomidine group，heart rate，blood pressure，plasma cortisol and noradrenaline in 1min afte