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右旋美托咪啶对小儿心脏手术麻醉中血流动力学及应激反应的影响
The Effects of Dexmedetomidine on Hemodynamics and Stress Reaction in Pediatrics Undergoing Anesthesia and Cardiac Surgery

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DOI:
作者:
凌云志
LING Yun-zhi
作者单位:
安徽蚌埠医学院第一附属医院麻醉科
Department of Anesthesiology，The First Affiliated Hospital of Bengbu Medical College
关键词:
右美托咪定；小儿心脏手术；血流动力学；应激反应
dexmedetomidine; Pediatric cardiac surgery; hemodynamics; stress reaction
摘要:
目的：探讨右美托咪定在小儿心脏手术麻醉中对血流动力学和应激反应的影响。方法：30例体外循环下实施心脏手术的小儿患者随机分为实验组和对照组，实验组微量泵泵入右美托咪定，对照组泵入等量生理盐水，分别记录麻醉和手术过程中5个时间点（T1：颈内静脉置管后，T2：劈胸骨后，T3：体外循环前，T4：体外循环结束时，T5：气管导管拔管时）生命体征的变化，包括平均动脉压、心率、BIS值及Ramsay评分，同时检测血糖值。放免法检测血浆皮质醇及醛固酮浓度的变化。结果：实验组在T1、T2、T3、T4、T5各时间点MAP均低于对照组，BIS值与对照组差异无统计学意义，Ramsay镇静评分与对照组差异有统计学意义（P＜0. 05），HR值在T1、T2、T4均低于对照组（P＜0. 05）。实验组血糖值在T1~T4各点均低于对照组（P＜0. 05），皮质醇在T2~T5各点与对照组差异均有统计学意义，低于对照组（P＜0. 05），醛固酮值在T1~T5各时间点均与对照组差异有统计学意义（P＜0. 05）。组内比较：实验组血糖及醛固酮值在T4、T5时间点与T1点比较，差异显著（P＜0. 05），皮质醇值在T5时间点与T1点比较差异有统计学意义（P＜0. 05）；对照组血糖及皮质醇值在T2、T4、T5时间点与T1点比较，差异均有统计学意义（P＜0. 05），醛固酮值在T2~T5各时间点与T1点比较，差异均有统计学意义（P＜0. 05）。结论：右美托咪定应用于小儿心脏手术麻醉中具有更好的循环稳定性且能更好地抑制应激反应。
Objective: To investigate the effects of dexmedetomidine on hemodynamics and stress reaction in pediatric undergoing anesthesia and cardiac surgery. Methods: Thirty pediatric patients underwent cardiac surgery were divided into experimental group and control group randomly. The patients were pumped into dexmedetomidine( experimental group) or equivalent sodium chloride (control group). The changes of vital signs including MAP, HR, BIS and Ramsay score were observed at five time points during anesthesia after jugular vein cannulation(T1), after spliting the sternum(T2), before cardiopulmonary bypass(T3), the end of cardiopulmonary bypass(T4), when extubation(T5). Blood samples were taken from vein at five time points for determination of blood glucose, cortisol and aldosterone. Results: The MAP in experimental group was significantly lower than those in control group at T1, T2, T3, T4 and T5. There were not significantly differences between two groups on BIS value, while Ramsay sedation value were significantly different (P＜0. 05). The HR was significantly lower than those in control group at T1, T2 and T4. The values of blood glucose were significantly lower than those in control group from T1 to T4(P＜0. 05). The values of cortisol were significantly lower than those in control group from T2 to T5(P＜0. 05).There were significantly differences in aldosterone value between two groups from T1 to T5(P＜0. 05). Comparisons in experimental groups showed that the levels of blood glucose and aldosterone were significantly different at T4 and T5 as compared with T1(P＜0. 05). There was significantly difference in cortisol value at T5 as compared with T1(P＜0. 05). Comparisons in control groups showed that the levels of blood glucose and cortisol were significantly different at T2, T4 and T5 as compared with T1（P＜0. 05）. There was significantly difference in aldosterone value from T2 to T5 as compared with T1(P＜0. 05). Conclusions: Dexmedetomidine can get more stable hemodynamics and inhibit the stress reaction better in Pediatric cardiac surgery.

 

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