预注右美托咪定对依托咪酯诱导全麻气管插管安全性研究简

目的：观察预注右美托咪定对依托咪酯诱导插管的患者安全性情况。方法：择期头颈部手术患者80例，随机分成四组：依托咪酯复合右美托咪定组（A组）、丙泊酚复合右美托咪定组（B组）、依托咪酯组（C组）、丙泊酚组（D组），每组20例。记录四组患者在入室后麻醉前基础值（T0）、给予右美托咪定开始1min（T1）、输注右美托咪定10min（T2）、麻醉诱导后3min为（T3）、插管即刻（T4）、插管后1min（T5）、插管后3min（T6）、插管后10rain（T7）的SBP、DBP、脑电双频指数（BIS）、心率（HR），记录T0、T2两个时点血氧饱和度（SpO2）值、Ramsay评分。结果：T2时点与T0时点比较，A、B组HR下降，并低于C、D组（P〈0．01），但对血压并未产生影响（P〉0．05）；T3时点跟T0时点比较，A、B、C三组SBP下降（P〈0．01），A、C组DBP下降（P〈0．01），B组DBP下降（P〈0．05），T4时点A组SBP高于B组（P〈0．01），A组DBP高于B组（P〈0．05）；T5、T6、T7时点A、B两组血压、HR比较无统计学差异（P〉0．05）。A、B两组SpO2值T2时点低于T0时点（P〈0．01），T2时点Ramsay评分，A、B两组高于C组（P〈0．05）。A、B组BIS值T2时点低于T0（P〈0．01），T3～T7时点三组均低于T0（P〈0．01），T5时点C、D组BIS值高于A、B组（P〈0．05）。结论：预注右美托咪定可以降低依托咪酯诱导全麻气管插管的心血管反应，保留较丙泊酚复合右美托咪定更好的循环调节功能，其抑制插管心血管反应效能和丙泊酚相似。

Effects of pre-injection of Dexmedetomidine on safety during Etomid- ate induction of general anesthesia

AIM. To observe the effect pre-in- jection of Dexmedetomidine on safety during Etomidate induction of general anesthesia. METHODS： Eighty patients with ASA Ⅰ-Ⅱscheduled for head or neck surgery were ran- domly assigned to 4 groups ： A （n=20）, B （ n = 20） ,C（n = 20）, D（n = 20）. Group A, B received Dexmedetomidine 1 #g/kg intravenous injection and the whole dose was given within 10 mi- nutes. Group C,D received equal volume of nor- mal saline as Group A intravenously without Dex. Anesthesia was induced with Sufentanil 0.5 μg/kg,Atracurium 0.6 mg/kg and Etomid- ate 0.2 mg/kg in group A, C . Anesthesia was induced with propofol 1.5 mg/kg in group B,D. All other induction and maintenance drugs were same for two groups. HR, SBP, DBP, BIS were recorded at the time points of pre-administration of Dexmedetomidine （To ,base value）,1 min after administration（T1 ）, 10 min after administration （T2）, pre-intubation （T3）, intubation （T4）, 1 min after intubation （T5）, 3 min after intubation （T6）, 10 min after intubation（T7 ）. SpO2 , Rame- say scale were recorded at the time points of To and T2. RESULTS：After Dexmedetomidine was given,SpO2 decreased （P〈0.01） and Ramesay scale increased in group A and group B （P 〈0.01）. There was no obvious change in group C,D（P〈0.05）. Compared with the base value, SBP and DBP of each group was decreased at T3 （P〈0.05） ; compared with the base value,SBP, DBP, and HR of Group C increased obviously with intubation （P 〈 0.05）, and HR remained higher than group A and group B after intuba- tion（P〈 0.01） ; Compared with the group C, SBP,DBP,and HR of group A and group B were lower at T4 and T3 （P〈0.05）. Compared with the group B, SBP and NBP of group A were higher at T4（P〈0.05）. SBP,DBP,and HR at T5- T7 were not signficantly different between group A and group B（P〉0.05）. Compared with the base value,BIS of group A and group B were decreased at T2（P〈0.01）, BIS of group A,B,D were lower than group C at T5 （P〈0.05）. CON- CLUSION： A single dose of Dexmedetomidine can effectively reduce cardiovascular responses to tracheal intubation during induction of general anaesthesia. Etomidate remain better instanta- neous cardiovascular response to laryngoscope and intubation than Propofol and is similar with Propofol in inhibiting the stress response after tracheal intubation during general anaesthesia.