腹腔镜胆囊切除术中丙泊酚和右美托咪定在血流动力学和应激方面的比较

腹腔镜胆囊切除术中丙泊酚和右美托咪定在血流动力学和应激方面的比较

贵州医科大学麻醉与心脏电生理课题组

翻译 :  安丽 

编辑 :  严旭 

审校 :  曹莹

背景:全身麻醉期间，手术和麻醉的实施常引起患者内分泌、免疫和代谢方面发生改变，此期间常通过应用麻醉药物减少患者应激激素水平和维持血流动力学稳定，来减少对内分泌系统的影响。

目的：本研究的目的是观察在腹腔镜胆囊切除术(LC)中，比较丙泊酚和右美托咪定维持麻醉对患者血流动力学和应激激素的影响。

方法：本研究纳入了择期LC患者70例。将患者随机分为丙泊酚组和右美托咪定组。丙泊酚组：予75 μg/kg/min丙泊酚维持麻醉，右美托咪定组：予0.5µg/kg/h右美托咪定维持麻醉。主要监测指标为监测并记录麻醉前至进入麻醉恢复室(PACU)后10min的血流动力学参数(心率和平均动脉压)、血糖和血清肾上腺素水平。

结果：与丙泊酚组相比，右美托咪定组在各时点的心率和平均动脉压变化均显著降低（P<0.001）。此外，右美托咪定组血糖和血清肾上腺素水平的升高显著高于丙泊酚组（P<0.001）。

结论：右美托咪定在麻醉期间维持血流动力学参数与丙泊酚相比有显著差异，右美托咪定在维持血流动力学参数方面效果较好，丙泊酚在降低应激激素方面效果优于右美托咪定，均可用于LC手术。

原始文献来源 ：  

Ali Ghomeishi, Ahmad Reza Mohtadi, Kaveh Behaeen , Sholeh Nesioonpour, Nima Bakhtiari  and Farzad Khalvati Fahlyani.Comparison of the Effect of Propofol and Dexmedetomidine on Hemodynamic Parameters and Stress Response Hormones During Laparoscopic Cholecystectomy Surgery.Anesth Pain Med. 2021 October; 11(5):e119446.Doi: 10.5812/aapm.119446.

英文原文

Comparison of the Effect of Propofol and Dexmedetomidine on Hemodynamic Parameters and Stress Response Hormones During Laparoscopic Cholecystectomy Surgery

Abstract 

Background: General anesthesia induces endocrine, immunologic, and metabolic responses. Anesthetic drugs affect the endocrine system by changing the level of stress hormones and hemodynamic variables of the patient.

Objectives: The purpose of this study was to compare the effects of propofol and dexmedetomidine on hemodynamic parameters and stress-induced hormones in laparoscopic cholecystectomy (LC) surgery.

Methods: Seventy patients of elective LC were included in this study. The patients were randomly assigned into two equal groups of propofol (75 µg/kg/min) and dexmedetomidine (0.5 µg/kg/hour) as anesthesia maintenance. Hemodynamic parameters (heart rate and mean atrial pressure), blood sugar, and serum epinephrine level were monitored and recorded from pre-anesthesia period to 10 min after entry to post-anesthesia care unit (PACU) according to a planned method.

Results: Heart rate and mean atrial pressure changes were significantly lower in dexmedetomidine group in all stages compared to propofol group (P < 0.001). Also, the rises in blood glucose and serum epinephrine levels in the dexmedetomidine group were significantly higher than in the propofol group (P < 0.001).

Conclusions: Anesthesia maintenance by dexmedetomidine showed a significant difference in hemodynamic parameters in comparison with propofol. While dexmedetomidine had better effects on controlling hemodynamic parameters, propofol showed better effects on decreasing stress hormones, and it can be suggested for LC surgery.

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