盐酸右美托咪定对腹膜假性黏液瘤患者术中血流动力学及应激反应的影响

　　[摘要] 目的 研究鹽酸右美托咪定对于腹膜假黏液瘤患者术中血流动力学及应激反应的影响。 方法 选择2015年6月～2017年10月北京市航天中心医院收治的腹膜假黏液瘤患者46例，采用随机数字表法分为右美托咪定组（24例）和对照组（22例）。两组患者进入手术室后给予0.5 μg/（kg·h）右美托咪定或等量盐水泵注，10 min后行麻醉诱导，在麻醉诱导前（T1）、气管插管后3 min（T2）、腹腔热灌注化疗前（T3）、热灌注结束（T4）、手术结束（T5）分别抽取动静脉血样进行检测，记录心率（HR）、有创动脉压（MAP）、心排出量（CO）、每搏变异度（SVV）、体温（Tnose）、血糖（Glu）、血浆去甲肾上腺素（NE）以及肾上腺素（E）前后变化。 结果 激素水平：右美托咪定组患者T2～T5时血浆E、NE水平低于对照组（P < 0.05）。血流动力学：右美托咪定组在T3～T5时，其CO、SVV变化优于对照组（P < 0.05）。术中右美托咪定组平均MAP高于对照组，丙泊酚用量少于对照组，差异有统计学意义（P < 0.05）。两组患者术前、术后PCI指数、CVP、Glu、手术时间、出血量、尿量、液体量差异无统计学意义（P > 0.05）。 结论 盐酸右美托咪定可以减轻腹膜假黏液瘤患者术中伤害性刺激的反应，有利于减少术中血流动力学波动。
　　[关键词] 腹膜假黏液瘤；应激反应；血流动力学；右美托咪定
　　[中图分类号] R735.5 [文献标识码] A [文章编号] 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.