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右美托咪定对大面积烧伤切痂植皮患者麻醉效果及应激反应的影响
Anesthetic Effect of Dexmedetomidine on Patients Who Would Undergo Escharectomy and Skin-grafting Due to Extensive Burn and Its Influence on these Patients’ Stress Response

邹磊.右美托咪定对大面积烧伤切痂植皮患者麻醉效果及应激反应的影响[J].中国烧伤创疡杂志,2020,(1):33~37.

DOI：

英文关键词:Dexmedetomidine General anesthesia Burns Escharectomy and skin grafting Anesthesia effect Stress response Influence

基金项目:

作者	单位
邹磊	信阳市中心医院

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中文摘要:

【摘要】目的对比分析右美托咪定对接受切痂植皮术治疗的大面积烧伤患者麻醉效果及应激反应的影响。方法选取2016年1月至2018年12月信阳市中心医院收治的需行切痂植皮术治疗的60例大面积烧伤患者作为研究对象，并采用随机数表法将其随机分为试验组（30例）和对照组（30例），试验组患者于麻醉诱导前及维持麻醉过程中予以右美托咪定进行干预，对照组患者于麻醉诱导前及维持麻醉过程中予以生理盐水进行干预，对比观察两组患者植皮面积、术中失血量、手术持续时间等手术相关指标以及不同时间点心率、动脉血压、肾上腺素、去甲肾上腺素、皮质醇及血糖水平的变化情况。结果麻醉诱导后、削痂、取皮、植皮、手术结束时，两组患者心率及动脉血压均呈先升高后降低趋势（试验组：F=13.450、18.120，P均=0.000；对照组：F=45.330、51.930，P均=0.000），且除麻醉诱导后两组患者动脉血压无明显差异（t=1.820，P=0.074）外，其他各时间点对照组患者心率及动脉血压均明显高于试验组（心率：t=5.875、9.657、9.523、7.435、5.425，P均=0.000；动脉血压：t=12.582、11.017、12.061、5.705，P均=0.000），差异具有统计学意义；麻醉诱导后、削痂、取皮、植皮、手术结束时，试验组患者血糖水平及对照组患者肾上腺素、去甲肾上腺素、皮质醇、血糖水平均呈先升高后降低趋势（F=3.694、30.140、2.934、21.840、71.590，P=0.003、0.000、0.014、0.000、0.000），且除麻醉诱导后两组患者去甲肾上腺素、皮质醇、血糖水平及手术结束时去甲肾上腺素水平无明显差异（t=0.178、1.076、0.433、1.739，P=0.859、0.287、0.667、0.087）外，其他各时间点对照组患者肾上腺素、去甲肾上腺素、皮质醇及血糖水平均明显高于试验组（肾上腺素：t=4.715、8.921、7.685、10.382、9.887，P均=0.000；去甲肾上腺素：t=2.423、2.022、2.483，P均=0.018、0.048、0.016；皮质醇：t=8.062、5.559、5.238、5.228，P均=0.000；血糖：t=8.180、5.656、5.394、9.174，P均=0.000），差异具有统计学意义。结论接受切痂植皮术治疗的大面积烧伤患者在全身麻醉过程中加用右美托咪定，可有效降低患者的应激反应程度，值得临床进一步深入研究探讨。

英文摘要:

【Abstract】Objective To compare and analyze the anesthetic effect of dexmedetomidine on patients who would undergo escharectomy and skin-grafting due to extensive burn and its influence on these patients’ stress response. Methods Sixty patients who would undergo escharectomy and skin-grafting due to extensive burn in Xinyang Central Hospital from January 2016 to December 2018 were selected as subjects and then divided, according to random number table, into an experiment group (30 cases) and a control group (30 cases). Before anesthesia induction and during maintenance of anesthesia, patients in the experiment group were intervened with dexmedetomidine whereas patients in the control group were treated with normal saline. Operation related indicators such as graft area, blood loss in operation, duration of operation as well as changes of heart rate, arterial blood pressure, epinephrine, norepinephrine, cortisol and blood glucose level at different time points in the two groups were compared and analyzed. Results After anesthesia induction and at the end of escharectomy, skin removal, skin grafting and operation, the heart rate and arterial blood pressure of patients in the two groups increased first and then decreased (experiment group: F = 13.450, 18.120, all P = 0.000; control group: F = 45.330, 51.930, all P = 0.000) and no significant difference was observed in arterial blood pressure between the two groups after anesthesia induction (t = 1.820, P = 0.074), but the heart rate and arterial blood pressure of patients in the control group were significantly higher than those in the experiment group at other time points (heart rate: t = 5.875, 9.657, 9.523, 7.435, 5.425, all P = 0.000; arterial blood pressure: t = 12.582, 11.017, 12.061, 5.705, all P = 0.000) and the results of comparison showed statistically significant difference. After anesthesia induction and at the end of escharectomy, skin removal, skin grafting and operation, the blood glucose levels of patients in the experiment group and the levels of epinephrine, norepinephrine, cortisol, and blood glucose in the control group increased first and then decreased (F = 3.694, 30.140, 2.934, 21.840, 71.590, P = 0.003, 0.000, 0.014 , 0.000, 0.000) and no significant difference was observed in the levels of norepinephrine, cortisol, blood glucose and noradrenaline after anesthesia induction and in the level of noradrenaline at the end of operation (t = 0.178, 1.076, 0.433, 1.739, P = 0.859, 0.287, 0.667, 0.087), but levels of epinephrine, norepinephrine, cortisol, and blood glucose in the control group were significantly higher than that in the experiment group at other time points (epinephrine: t = 4.715, 8.921, 7.685, 10.382, 9.887, all P = 0.000; norepinephrine: t = 2.423, 2.022, 2.483, all P = 0.018, 0.048, 0.016; Cortisol: t = 8.062, 5.559, 5.238, 5.228, all P = 0.000; blood glucose: t = 8.180, 5.656, 5.394, 9.174, all P = 0.000) and the results of comparison showed statistically significant difference. Conclusion For patients who will undergo escharectomy and skin grafting due to extensive burn, dexmedetomidine can reduce their stress response when they get general anesthesia, so it deserves further clinical research.