右美托咪啶用于预防全身麻醉气管插管心血管反应的临床观察

目的观察右美托咪啶（dexmedetomidine,DXM）用于预防全身麻醉气管插管心血管反应的效果。方法将ASAⅠ-Ⅱ级、无异常手术麻醉史,心电图、肝肾功能及电解质正常、拟在全身麻醉下行择期手术的30例患者,按随机数字表法分为2组,右美托咪啶组和对照组,每组15例。右美托咪啶组静脉泵注右美托咪啶1μg.kg-1,10 min泵注完;对照组则静脉泵注等量的生理盐水。2组诱导用药均为咪唑安定0.1 mg.kg-1、芬太尼4μg.kg-1、维库溴铵0.1 mg.kg-1及依托咪酯0.3 mg.kg-1。对2组给药前、给药后、插管前、插管时,插管后1、3、5 min的收缩压（SBP）、舒张压（DBP）、心率（HR）的变化进行比较。结果 2组患者插管时、插管后1 min的BP、HR与给药前、给药后、插管前比较均有不同程度升高,但右美托咪啶组的升高程度明显低于对照组（P〈0.01）;右美托咪啶组的HR在给药后、插管前,插管后3、5 min较给药前明显下降（均P〈0.01）。右美托咪啶组有1例患者给药后出现显著的心动过缓,经给予阿托品0.5 mg后恢复至正常。结论右美托咪啶能显著减轻气管插管时的心血管反应,维持血流动力学的稳定。

Dexmedetomidine for Prevention of Cardiovascular Response to Tracheal Intubation during General Anesthesia

Objective To observe the effects of dexmedetomidine on cardiovascular response to tracheal intubation during general anesthesia.Methods Thirty patients（ASA classⅠ-Ⅱ） scheduled for elective operations under general anesthesia,who had normal physical examination（electrocardiogram,liver and kidney function and electrolytes） without a history of anesthesia exception,were randomly assigned to receive either intravenous infusion of 1μg·kg-1 dexmedetomidine（dexmedetomidine group,n=15）or intravenous infusion of the same amount of normal saline（controlled group,n=15）.Anesthesia was induced with midazolam 0.1 mg·kg-1,fentanyl 4 μg·kg-1,vecuronium 0.1 mg·kg-1 and etomidate 0.3 mg·kg-1 in both groups.Systolic blood pressure（SBP）,diastolic blood pressure（DBP） and heart rate（HR） were recorded before infusion,after infusion,before intubation,during intubation,and 1,3 and 5 minutes after intubation.Results Blood pressure（BP） and HR increased during intubation and 1 minute after intubation in both groups（P0.01）,but the increase in dexmedetomidine group was smaller than that in control group（P0.01）.After infusion,before intubation,and 3 and 5 minutes after intubation,HR significantly decreased in dexmedetomidine group,compared with the control value and the value before infusion（P0.01）.Bradycardia occured in 1 patient after dexmedetomidine infusion,but reverted to normal after administration of 0.5 mg atropine.Conclusion Dexmedetomidine can effectively reduce cardiovascular responses to tracheal intubation during general anesthesia.