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1、右美托咪定预防全身麻醉苏醒期应激反应临床研究朱月皓刘文值钟海蓉韩洪波四川省攀枝花市中丙医结合医院麻醉科四川攀枝花617000目的：观察右美托咪定对全身麻醉下腹腔镜切除肭囊患者苏醒期气管拔管前后应激反应的影响。方法：选择拟行全身麻醉下腹腔镜胆囊切除术患者50例，ASAI或II级，随机分为对照组(N组)和右美托咪定组(D组)，每组各25例，右美托咪定组术前静脉微量泵给予负荷量右美托咪定0.8ug/kg与生理盐水配置20ml,推注时间15分钟，维持剂量为0.2ug/(kg.h),对照组术前静脉微量泵给
2、予0.9%生理盐水20ml,推注时间15分钟，均在手术结束前30分钟停止。芬太尼-异丙酚-琥珀肭碱诱导，瑞芬太尼-异丙酚-维库溴铵维持，术毕呼吸恢复后拔管。观察并记录患者入手术室T0,拔管前T1,拔管后1分钟T2,拔管后5分钟T3,拔管后10分钟T4的血压、心率的变化，并在各时段点抽取静脉血测血浆皮质醇和去甲肾上腺素的浓度。结果：右美托咪定组血压、心率、血浆皮质醇、去甲肾上腺素在拔管后lmin、拔管后5min、拔管后lOmin无明显波动，无统计学意义。对照组血压、心率、血浆皮质醇、去甲肾上腺素较
3、右美托咪定组在拔管前lmin、拔管后lmin、拔管后5min、拔管后lOmin均有增髙(P<0.05)。结论：全麻期间持续应用盐酸右美托咪定能有效维持全麻苏醒期血流动力学的稳定，降低患者全麻苏醒期血浆皮质醇和去甲肾上腺素水平，降低全身麻醉苏醒期应激反应。关键词：右美托咪定；全麻苏醒期；应激反应Abstract：Objective：Toobservetheeffectsofdexmedetomidineanesthesiaoflaparoscopiccholecystectomyinpati
4、entswithtrachealextubationafterstressresponseofthebody.Methods：undergeneralanesthesiaundergoinglaparoscopiccholecystectomyin50patients，ASAIorII，wererandomlydividedintocontrolgroup(groupN)anddexmedetomidinegroup(Dgroup)，25casesineachgroup,dexmedetomid
5、inegroupofpreoperativeintravenousmicropumpwithloadingdoseofdexmedetomidine0.8ug/kgandsaline20mlconfiguration,injectiontimeof15minutes，amaintenancedoseof0.2ug/(kg.h),thecontrolgroupofpreoperativeintravenousmicropumpwith0.9%normalsaline20ml，injectionti
6、meof15minutes，inthestop30minutesbeforetheendofoperation.Fentanyl，propofolandsuccinylcholineinducedbyremifentanilpropofol,vecuroniumbromide,postoperativerespiratoryrecoveryafterextubation.ObserveandrecordthepatientsintotheoperationroomTObeforeextubati
7、on，Tlafterextubation，T2afterextubationin1minutes，5minutesand10minutesT4T3,changesofbloodpressure，heartrateafterextubation,andvenousbloodsamplesineachperiodofmeasurementofplasmacortisolandnorepinephrineconcentration.Results：Dexmedetomidinegroup，heartr
8、ate，bloodpressure,plasmacortisolandnoradrenalineinlminafterextubation，5minafterextubation,lOminafterextubationwithoutobviousfluctuation，nostatisticalsignificance.Controlofbloodpressure，heartrate,plasmacortisol,norepinephrinecomparedwithdexmedetomidin
