摘要
目的 探讨右美托咪定在腰硬联合麻醉中的应用效果及对患者血流动力学、肾素-血管紧张素-醛固酮系统(renin angiotensin aldosterone system,RAAS)的影响.方法 选择2013年10月~2016年10月在海宁市中心医院在腰硬联合麻醉下实施开腹手术的92例患者,按照随机数字法分为2组,右美托咪定组(46例)在麻醉前给予右美托咪定,对照组(46例)给予氯化钠溶液.比较2组手术情况以及麻醉前(T1)、麻醉后10min(T2)、手术结束时(T3)及手术结束后30min(T4)时平均动脉压(mean arterial pressure,MAP)、心率、血浆肾素活性(plasma renin activity,PRA)、血管紧张素(angiotensin Ⅱ,ANG-Ⅱ)、醛固酮(aldosterone,ALD)的变化.结果 2组患者在手术时间、术中出血量、术中输液量、苏醒时间上差异无统计学意义;2组患者在T1时点MAP、HR水平差异无统计学意义,在T2、T3、T4时点,对照组MAP、心率均发生显著变化(P<0.05),右美托咪定组无显著变化(P<0.05);右美托咪定组T2、T3、T4时点MAP、心率水平均比对照组低(P<0.05);2组患者在T1时点PRA、ANG-Ⅱ、ALD水平差异无统计学意义;2组患者在T2、T3时点PRA、ANG-Ⅱ、ALD水平出现上升,T4时点回落,和同组T1时点比较差异有统计学意义(P<0.05);但右美托咪定组在T2、T3、T4时点,PRA、ANG-Ⅱ、ALD水平均比对照组低(P<0.05).结论 在腰硬联合麻醉患者麻醉前应用右美托咪定,可保持术中血流动力学稳定,并抑制RAAS的激活.
Abstract
Objective To study the application of dexmedetomidine in patients with combined spinal epidural anesthesia and its effects on hemodynamics and renin angiotensin aldosterone system (RAAS).Methods96 patients with open surgery under combined spinal epidural anesthesia from Oct.2013 to Oct.2016 in our hospital were selected.Divided into two groups by randomly, the dexmedetomidine group(46 cases) was given dexmedetomidine before anesthesia, the control group(46 cases) was given sodium chloride solution.The operation condition, and the changed of mean arterial pressure (MAP), heart rate, plasma renin activity (PRA), angiotensin II (ANG-II) and aldosterone (ALD) at before anesthesia (T1), post anesthesia 10min (T2), end of the operation (T3) and end of the operation 30 min (T4) were compared.ResultsThere was no significant difference in the operation time, blood loss, intraoperative transfusion, and wake up time between the two groups;there was no significant difference in MAP and heart rate between the two groups at T1, at T2, T3, T4 point, control group MAP, heart rate were significantly changed(P<0.05), and there was no significant change in dexmedetomidine group, at T2,T3,T4 point, the levels of MAP, heart rate in the dexmedetomidine group were lower than the control group(P<0.05);there was no significant difference between the two groups in PRA, ANG-Ⅱ and ALD at T1, at T2 and T3 point, the PRA, ANG-Ⅱ and ALD in the two groups were increased, at T4 point down, there were significant differences compared with the same group at T1(P<0.05);but at T2,T3,T4, the levels of PRA,ANG-Ⅱ,ALD were lower than the control group(P<0.05).ConclusionIn the combined spinal epidural anesthesia with dexmedetomidine before anesthesia, which can Maintain hemodynamic stability, And inhibit the activation of RAAS.
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