鹽酸右美托咪定對(duì)腹膜假性黏液瘤患者術(shù)中血流動(dòng)力學(xué)及應(yīng)激反應(yīng)的影響

　　[摘要] 目的 研究鹽酸右美托咪定對(duì)于腹膜假黏液瘤患者術(shù)中血流動(dòng)力學(xué)及應(yīng)激反應(yīng)的影響。 方法 選擇2015年6月～2017年10月北京市航天中心醫(yī)院收治的腹膜假黏液瘤患者46例，采用隨機(jī)數(shù)字表法分為右美托咪定組（24例）和對(duì)照組（22例）。兩組患者進(jìn)入手術(shù)室后給予0.5 μg/（kg·h）右美托咪定或等量鹽水泵注，10 min后行麻醉誘導(dǎo)，在麻醉誘導(dǎo)前（T1）、氣管插管后3 min（T2）、腹腔熱灌注化療前（T3）、熱灌注結(jié)束（T4）、手術(shù)結(jié)束（T5）分別抽取動(dòng)靜脈血樣進(jìn)行檢測(cè)，記錄心率（HR）、有創(chuàng)動(dòng)脈壓（MAP）、心排出量（CO）、每搏變異度（SVV）、體溫（Tnose）、血糖（Glu）、血漿去甲腎上腺素（NE）以及腎上腺素（E）前后變化。 結(jié)果 激素水平：右美托咪定組患者T2～T5時(shí)血漿E、NE水平低于對(duì)照組（P < 0.05）。血流動(dòng)力學(xué)：右美托咪定組在T3～T5時(shí)，其CO、SVV變化優(yōu)于對(duì)照組（P < 0.05）。術(shù)中右美托咪定組平均MAP高于對(duì)照組，丙泊酚用量少于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P < 0.05）。兩組患者術(shù)前、術(shù)后PCI指數(shù)、CVP、Glu、手術(shù)時(shí)間、出血量、尿量、液體量差異無統(tǒng)計(jì)學(xué)意義（P > 0.05）。 結(jié)論 鹽酸右美托咪定可以減輕腹膜假黏液瘤患者術(shù)中傷害性刺激的反應(yīng)，有利于減少術(shù)中血流動(dòng)力學(xué)波動(dòng)。
　　[關(guān)鍵詞] 腹膜假黏液瘤；應(yīng)激反應(yīng)；血流動(dòng)力學(xué)；右美托咪定
　　[中圖分類號(hào)] R735.5 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1673-7210（2018）02（c）-0132-05
　　Effects of Dexmetomidine hydrochloride on hemodynamics and stress response in patients with pseudomyxoma peritonei
　　LU Liangyuan XUE Yanyan ZHANG Guyue YANG Zhanmin
　　Department Anesthesiology， Beijing Aerospace Center Hospital， Beijing 100049， China
　　[Abstract] Objactive To study the effects of Dexmedetomidine hydrochloride on hemodynamics and stress response in patients with pseudomyxoma peritonei. Methods Forty-six patients with pseudomyxoma peritonei in Beijing Aerospace Center Hospital from June 2015 to October 2017 were selected and devided into Dexmedetomidine group （24 cases） and control group （22 cases） by randomly number table method. After entered the operating room， patients of two groups were given the 0.5 μg/kg·h Dexmedetomidine or the same dose of normal saline， after 10 minutes， anesthesia induction. The blood samples were extracted and tested at the time before anesthesia induction （T1）， 3 minutes after endotracheal intubation （T2）， before intraperitoneal hyperthermic perfusion chemotherapy （T3）， after thermal perfusion （T4）， end of the surgery （T5）. The heart rate （HR）， MAP， cardiac output （CO）， stroke volume variation （SVV）， Tnose， blood glucose （Glu）， plasma norepinephrine （NE） and epinephrine （E） were recorded. Results Hormone levels： the plasma E and NE levels in Dexmedetomidine group were lower than control group at T2-T5 （P < 0.05）. Hemodynamics： In Dexmedetomidine group of T3， T4 and T5， the change of CO and SVV was better than that of normal saline control group （P < 0.05）. The average MAP in Dexmedetomidine group was higher than the control group， the dosage of Propofol was lower than that of control group， the differences were statistically significant （P < 0.05）. There was no statistical significance between the two groups in preoperative， postoperative PCI index， CVP， Glu， time of operation， blood volume， urine volume and liquid amount （P > 0.05）. Conclusion Dexmedetomidine hydrochloride can reduce the reaction of injury in patients with pseudomyxoma peritonei， which is beneficial to reduce the hemodynamic fluctuation during the operation.

相關(guān)熱詞搜索：腹膜 黏液 應(yīng)激 鹽酸 動(dòng)力學(xué)