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目的 :研究右美托咪定预处理对食管癌根治术单肺通气患者应激反应的影响。方法 :择期食管癌根治术患者40例,ASA分级Ⅱ~Ⅲ,性别不限,年龄45~65岁,体重指数18~25 kg/m2,采用随机数字表法将其分为2组:对照组(C组)、右美托咪定组(D组),每组20例。D组入室前2 h经静脉输注右美托咪定负荷量预处理,以0.2μg/(kg·min)持续输注至麻醉诱导前10 min调整为0.6μg/(kg·min),关胸后恢复为0.2μg/(kg·min)至拔除气管导管;C组给予等容生理盐水。记录患者入室前(T1)、诱导前(T2)、气管插管即刻(T3)、切皮(T4)、单肺通气30 min(T5)、术毕(T6)、拔管后(T7)心率、血压、血糖变化;采用放射免疫法测定肾上腺素(epinephrine,E)、去甲肾上腺素(norepinephrine,NE)浓度。结果:与C组比较,D组患者术中心率于T2~T7时减低、收缩压、舒张压于T3~T4时降低,血糖自T3~T7时降低,血浆E、NE于T2~T7时降低(P<0.05)。与T1时比较,C组患者心率T3~T5时增高,平均动脉压于T3~T4时增高,血糖于T4~T7时增高,血浆E、NE于T2~T7时增高明显(P<0.05)。结论:右美托咪定预处理可有效降低食管癌根治术单肺通气患者应激反应。
Objective: To study the effect of dexmedetomidine preconditioning on stress response in patients with esophageal carcinoma undergoing single lung ventilation. Methods: Forty patients with esophageal cancer undergoing elective esophagectomy were divided into two groups according to random number table: control group (ASA class Ⅱ ~ Ⅲ, age range 45-65 years, body mass index 18 ~ 25 kg / m2) (Group C), dexmedetomidine group (group D), 20 cases in each group. Rats in group D were pretreated with intravenous infusion of dexmedetomidine 2 hours before infusion and were continuously infused at 0.2μg / (kg · min) to 0.6μg / (kg · min) 10 min before induction of anesthesia Chest recovery 0.2μg / (kg · min) to the removal of the tracheal tube; C group given equal volume of saline. The heart rate (HR), heart rate (T6), heart rate (T7) and temperature before extubation (T1), before induction (T2), immediately after intubation (T3) , Blood pressure and blood glucose. The concentrations of epinephrine (E) and norepinephrine (NE) were measured by radioimmunoassay. Results: Compared with group C, the operative heart rate in group D decreased from T2 to T7, systolic and diastolic blood pressure decreased from T3 to T4, blood glucose decreased from T3 to T7, and plasma E and NE decreased from T2 to T7 (P <0.05). Compared with T1, heart rate of group C increased from T3 to T5, mean arterial pressure increased from T3 to T4, blood glucose increased from T4 to T7, and plasma E and NE increased significantly from T2 to T7 (P <0.05). Conclusion: Dexmedetomidine preconditioning can effectively reduce the stress response in patients with esophageal carcinoma undergoing single lung ventilation.