[1]谢 力,贺宏智△,何 恒.右美托咪定对79例椎管内麻醉手术患者应激反应的影响研究[J].陕西医学杂志,2019,(3):373-376.
　XIE Li,HE Hongzhi,HE Heng.Clinical effect of dexmedetomidine on stress response in 79patients undergoing intraspinal anesthesia[J].,2019,(3):373-376.
点击复制

右美托咪定对79例椎管内麻醉手术患者应激反应的影响研究
分享到：

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
期数:
2019年3期
页码:
373-376
栏目:
基础研究
出版日期:
2019-03-05

文章信息/Info

Title:
Clinical effect of dexmedetomidine on stress response in 79patients undergoing intraspinal anesthesia
文章编号:
DOI:10.3969/j.issn.10007377.2019.03.024
作者:
谢 力; 贺宏智△; 何 恒
陕西省安康市中医医院手术麻醉科（安康725000）
Author(s):
XIE Li; HE Hongzhi; HE Heng
Operative Anesthesiology，Ankang Hospital of Traditional Chinese Medicine in Shaanxi Province（Ankang 725000）
关键词:
右美托咪定; 椎管内麻醉; 应激反应; AAI值; 血浆皮质醇
Keywords:
Key words Dexmedetomidine;  Intraspinal anesthesia;  Stress response;  AAI value;  Plasma cortisol
分类号:
R614.2
文献标志码:
A
摘要:
摘 要 目的:探讨右美托咪定对椎管内麻醉手术患者应激反应的影响。方法:选择椎管内麻醉手术患者79例，将其随机分为观察组（OG，n=40）和对照组（CG，n=39）。对照组给予丙泊酚，观察组给予右美托咪定。记录两组患者不同时间点的AAI值、MAP、HR、血浆皮质醇水平；对比分析两组患者不良反应发生情况。结果：T4时刻，两组血浆皮质醇水平较T0时刻均显著降低（t=5.542、12.850，均P＜0.01）；且OG血浆皮质醇水平显著低于CG（t=-9.125，P＜0.01）。T1T4时刻，两组AAI值较T0时刻均显著下降（t=6.740、10.530、6.514、5.557、2.878、6.757、3.665、3.626，均P＜0.01）；OG AAI值均显著低于CG（t=-4.010、-3.915、-3.657、-2.202，均P＜0.05）。T1T4时刻，两组MAP值较T0时刻均显著下降（t=7.576、14.270、17.347、14.397、5.907、7.846、7.604、5.537，均P＜0.01）；T2T4时刻，CG MAP值均显著低于CG（t=-6.858、-10.511、-9.524，均P＜0.01）。T1T4时刻，OG HR值较T0时刻均显著下降（t=2.119、5.233、7.087、6.142，均P＜0.05）；OG HR值均显著低于CG（t=-1.989、-4.907、-7.668、-6.702，均P＜0.05）。OG不良反应发生率为10.00%，明显低于CG 33.33%（χ2 =6.366，P＜0.05）。结论: 右美托咪定应用于椎管内麻醉患者镇静作用明显，可有效抑制应激反应的发生，稳定AAI及血流动力学指标，安全性高，值得推广应用。
Abstract:
Abstract Objective: This study aims to investigate the effect of dexmedetomidine on stress response in patients undergoing intraspinal anesthesia. Methods: 79 patients who underwent surgery were randomly divided into observation group (OG, n=40) and control group (CG, n=39). The CG was given propofol assisted anesthesia, and the OG was given dexmedetomidine. The level of AAI, MAP, HR and plasma cortisol which recorded at different time points and the adverse reaction was compared and analyzed in the two groups. Results: At T4, the level of plasma cortisol in both groups were significantly lower than those of at T0 (t=5.542、12.850，all P＜0.01). The level of plasma cortisol in OG was significantly lower than those in CG (t=-9.125，P＜0.01). At the time of T1T4, the value of AAI of both groups decreased significantly lower than those of T0 (t=6.740、10.530、6.514、5.557、2.878、6.757、3.665、3.626，all P＜0.01); the value of AAI in OG was significantly lower than those of CG (t=-4.010、-3.915、-3.657、-2.202，all P＜0.05). At T1T4, the value of MAP of both groups decreased significantly lower than those of T0 (t=7.576、14.270、17.347、14.397、5.907、7.846、7.604、5.537，all P＜0.01). At T2T4, the value of MAP of the OG was significantly lower than those of the CG (t=-6.858、-10.511、-9.524，all P＜0.01). At T1T4, the value of HR in OG was significantly lower than those of the T0 (t=2.119、5.233、7.087、6.142，all P＜0.05); and the value of HR in OG was significantly lower than those of the CG (t=-1.989、-4.907、-7.668、-6.702，all P＜0.05). The incidence of adverse reactions in the OG was 10%, which significantly lower than that of 33.33% in the CG (χ2=6.366, P＜0.05). Conclusion: Dexmedetomidine has obvious sedative effect in spinal anesthesia patients. It can effectively inhibit the occurrence of stress reaction, stabilize AAI and hemodynamic indexes. It is safe and worth popularizing. 

参考文献/References:

[1] 谭选军, 申黎光, 张 川, 等. 腰硬联合麻醉与持续硬膜外麻醉用于剖宫产术的效果对比分析[J]. 陕西医学杂志, 2015,44(2):180182.
[2] 李思妤, 申 乐, 黄宇光. 椎管内应用芬太尼所致瘙痒及其治疗[J].临床麻醉学杂志, 2016,32(3):302305. \[3\] 陈坤明, 焦相学. 盐酸右美托咪定对老年椎管内麻醉手术患者术中应激反应的影响研究[J]. 河北医药, 2016,38(13):19571959. \[4\] 王长社, 闻大翔, 李胜华, 等. 超声在椎管内麻醉中的应用[J]. 徐州医学院学报, 2015,35(2):137140. \[5\] 唐慧敏, 赵 艳, 郭向阳. 麻醉辅助用药和方法减轻应激反应的研究现状[J]. 中国微创外科杂志,2017,17(4):354356.
[6] 金 震, 张晓群, 崔 旭. 右美托咪定在椎管内麻醉术中的临床价值探析[J]. 湖南师范大学学报：医学版, 2017,14(5):8789.
[7] 杨 杰, 邱灿金. 右美托咪定辅助镇静对老年患者椎管内麻醉术后睡眠质量的影响[J]. 中国乡村医药, 2016,23(18):1213.
[8] 安政庄, 杨宗林, 张玉勤. BIS监测调控麻醉深度对老年高血压患者术中应激反应的影响[J]. 陕西医学杂志, 2017,46(3):352354.
[9] 侯源源, 闻庆平. 右美托咪定应用于椎管内麻醉的研究进展[J].国际麻醉学与复苏杂志, 2014,35(8):735738. 
[10] 胡明权, 缪冬梅, 刘 睿, 等. 右美托咪定对椎管内麻醉手术患者应激反应的影响[J]. 临床麻醉学杂志, 2015,31(1):1214.
[11] 鲍 红. 两种不同麻醉方式对老年人工股骨头置换术患者术后认知功能影响[J]. 陕西医学杂志, 2015,44(10):13631365.
[12] 张 英, 綦欣竹, 袁雪梅, 等. 静脉泵注右美托咪定对椎管内麻醉患者呼吸循环的影响[J]. 重庆医学, 2016,45(19):26922694.
[13] 辛小平, 郭清源, 陈美英, 等. 椎管内麻醉术中右美托咪定辅助用药对患者应激反应的影响[J]. 吉林医学, 2018,39(7):12971298.
[14] 巩红岩, 段文姣, 刘景景, 等. 超声引导连续胸椎旁神经阻滞复合右美托咪定麻醉对食管癌手术患者围术期应激反应的影响[J]. 新乡医学院学报, 2016,33(4):291296.
[15] 杨 帆, 张 微. 右美托咪定对椎管内麻醉手术患者应激反应的影响[J]. 中国医院用药评价与分析, 2018,18(1):5859.
[16] 柴 林, 刘智慧, 郑智文, 等. 靶控输注依托咪酯联合瑞芬太尼对老年手术患者机体免疫及应激反应指标的影响[J]. 中国药房, 2017,28(15):20362039.
[17] 孙志强. 右美托咪定在行椎管内麻醉老年患者中的镇静效果及其对患者血流动力学的影响[J]. 临床合理用药杂志, 2017,10(15)：7374.
[18] 田 娜, 黄 宁, 张 建. 右旋美托咪定对肝癌患者手术应激反应的影响[J]. 现代肿瘤医学, 2017,25(8):13091312.

相似文献/References:

[1]区浩林.右美托咪定联合瑞芬太尼TCI清醒镇静镇痛在输尿管镜钬激光碎石术中临床研究*[J].陕西医学杂志,2019,(1):32.
[2]顾国清,张海东,唐 鸣.髋关节置换患者术后镇痛中右美托咪定应用浓度研究[J].陕西医学杂志,2019,(3):370.
　GU Guoqing,ZHANG Haidong,TANG Ming.Study on the application concentration of dexmedetomidine in postoperative analgesia for patients with hip replacement[J].,2019,(3):370.
[3]周维纲,王宇波△,杨建治,等.右美托咪定对分娩镇痛产妇产程和脐动脉血气的影响*[J].陕西医学杂志,2019,(8):1074.
　ZHOU Weigang,WANG Yubo,YANG Jianzhi,et al.Effect of dexmedetomidine on the duration of labor and umbilical artery blood gas in painless parturient[J].,2019,(3):1074.
[4]刘 明,常红侠△.右美托咪定复合罗哌卡因腹横肌平面阻滞对腹腔镜下腹股沟〖JZ〗斜疝高位结扎术患儿血流动力学及麻醉质量的影响研究*[J].陕西医学杂志,2019,(10):1268.
　LIU Ming,CHANG Hongxia..Effects of dexmedetomidine combined with ropivacaine on the transverse hemifacial plane block on〖JZ〗hemodynamics and anesthesia quality in children undergoing high ligation of inguinal hernia[J].,2019,(3):1268.
[5]冯 健,邓挚玺△.右美托咪定联合舒芬太尼与右美托咪定联合地佐辛〖JZ〗用于胶质瘤患者术后镇痛临床研究*[J].陕西医学杂志,2019,(10):1289.
[6]秦 悦,董补怀,赵元廷,等.多模式镇痛对老年颈后路手术患者血流动力学及术后早期疼痛效果研究[J].陕西医学杂志,2019,(10):1355.
　QIN Yue,DONG Buhuai,Zhao Yuanting,et al.Effect of multimodal analgesia on hemodynamics and early postoperative 〖JZ〗pain in elderly patients with posterior cervical surgery[J].,2019,(3):1355.
[7]和优娟,喻 倩,庄莹莹△.右美托咪定复合全麻对急性脑出血患者脑保护作用研究*[J].陕西医学杂志,2019,(12):1702.
　HE Youjuan,YU Qian,ZHUANG Yingying.Cerebral protection effect of dexmedetomidine combined with general anesthesia on patients with acute cerebral hemorrhage[J].,2019,(3):1702.
[8]张力召,魏光辉.右美托咪定滴鼻联合七氟醚吸入对磁共振成像检查婴幼儿镇静作用的研究*[J].陕西医学杂志,2020,49(1):93.
[9]霍建臻,刘 江△.右美托咪定在喉镜下声带手术麻醉中的应用效果分析[J].陕西医学杂志,2020,49(6):745.[doi:DOI:10.3969/j.issn.10007377.2020.06.026]
[10]卢志方,郭 斌,董补怀,等.单纯全身麻醉与复合硬膜外应用右美托咪定和吗啡麻醉203例对比研究[J].陕西医学杂志,2020,49(7):858.[doi:DOI:10.3969/j.issn.10007377.2020.07.025]

更新日期/Last Update: 2019-03-15