摘要
目的探讨右美托咪定对全身麻醉下腹腔镜子宫切除术中血流动力学及应激反应的影响。方法采用前瞻性研究方法,选取2017年1月至2019年8月南京大学附属鼓楼医院收治的78例拟行全身麻醉下腹腔镜子宫切除术患者,按照简单随机化方法将患者分为对照组和观察组,每组各39例。对照组患者常规全身麻醉,观察组患者在此基础上于麻醉诱导前静脉泵注右美托咪定0.5μg/kg,10 min输注完毕,术中以0.3μg/(kg·h)持续泵注右美托咪定。比较两组患者入室后(T 0)、麻醉诱导后(T 1)、气管插管时(T 2)、手术开始时(T 3)、手术结束即刻(T 4)的血流动力学指标[心率(HR)、平均动脉压(MAP)]、应激反应指标[超氧化物歧化酶(SOD)、丙二醛(MDA)]、肌松效果指标(顺式阿曲库铵用量,起效时间,15%、30%、45%恢复时间)、麻醉恢复指标[自主呼吸恢复时间、拔管时间、苏醒时间、镇静-觉醒评分(OAA/S)]、不良反应、简易智力状态检查量表(MMSE)评分、血清磷酸化-P38丝裂原活化蛋白激酶(p-P38MAPK)、磷酸化JNK(p-JNK)水平。结果T 1、T 2、T 3、T 4时刻,观察组患者的HR分别为(85.71±9.08)次/min、(99.27±6.32)次/min、(102.35±10.03)次/min、(94.17±7.44)次/min,小于对照组的(80.12±10.62)次/min、(112.59±8.05)次/min、(119.12±8.79)次/min、(105.81±8.15)次/min(P<0.05),T 1、T 2时刻,观察组MAP分别为(70.85±4.13)mmHg、(81.15±5.41)mmHg,高于对照组的(67.91±5.05)mmHg、(87.62±7.26)mmHg,T 3、T 4时刻观察组MAP分别为(88.67±5.25)mmHg、(82.02±7.18)mmHg,低于对照组的(95.19±7.08)mmHg、(90.27±9.07)mmHg(P<0.05),观察组T 1、T 2、T 3、T 4时刻SOD分别为(302.94±32.46)U/L、(290.52±30.52)U/L、(281.05±32.95)U/L、(274.59±28.91)U/L,高于对照组的(272.61±40.19)U/L、(257.54±35.97)U/L、(249.98±33.28)U/L、(235.66±30.07)U/L,MDA分别为(4.29±1.12)nmol/ml、(4.55±1.24)nmol/ml、(4.69±1.17)nmol/ml、(4.74±0.93)nmol/ml,低于对照组的(4.82±0.97)nm
Objective To investigate the effects of Dexmedetomidine on hemodynamics and stress response during laparoscopic hysterectomy under general anesthesia.Methods A prospective study method was used,78 patients performed laparoscopic hysterectomy under general anesthesia were selected from Gulou Hospital Affiliated to Nanjing University from January 2017 to August 2019.Patients were divided into a control group and an observation group according to a simple randomization method,with 39 patients in each group.Patients in the control group received general anesthesia,on the basis of this,patients in the observation group were intravenously injected with dexmedetomidine 0.5μg/kg before induction of anesthesia,after 10 minutes of infusion,dexmedetomidine was continuously pumped intraoperatively at 0.3μg/(kg·h).The hemodynamic parameters[heart rate(HR),mean arterial pressure(MAP)],stress response indicators[superoxide dismutase(SOD),malondialdehyde(MDA)],and muscle relaxation effect indicators(Cis-atracurium dosage,onset time,15%,30%,45%recovery time),anesthesia recovery indicators[respiratory recovery time,extubation time,awake time,sedation-awakening score(OAA/S)],adverse reactions,simple mental state examination scale(MMSE)score,serum phosphorylated-P38 mitogen-activated protein kinase(p-P38MAPK),and phosphorylated JNK(p-JNK)levels after admission(T 0),after induction of anesthesia(T 1),at the time of tracheal intubation(T 2),at the beginning of surgery(T 3),and immediately after the end of surgery(T 4)in the two groups were compared.Results At T 1,T 2,T 3,and T 4,the HR of the observation group were(85.71±9.08)times/min,(99.27±6.32)times/min,(102.35±10.03)times/min,(94.17±7.44)times/min,which were less than those of the control group(80.12±10.62)times/min,(112.59±8.05)times/min,(119.12±8.79)times/min,(105.81±8.15)times/min(P<0.05).At T 1 and T 2,the MAP of the observation group were(70.85±4.13)mmHg,(81.15±5.41)mmHg,which were higher than those of the control group(67.91±5.05)mmHg,(87.62±7.26)mmHg,at the
作者
吴瑶
李亚玲
李建长
WU Yao;LI Ya-ling;LI Jian-chang(Department of Anesthesiology,Gulou Hospital Affiliated to Nanjing University,Nanjing Jiangsu 210008,China;Department of Obstetrics and Gynecology,Gulou Hospital Affiliated to Nanjing University,Nanjing Jiangsu 210008,China)
出处
《临床和实验医学杂志》
2020年第10期1108-1113,共6页
Journal of Clinical and Experimental Medicine
基金
江苏省妇幼保健协会科研项目(编号:FYX201921)。
