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麻醉前口服可乐定对体外循环期间应激反应的影响 |
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石碧明 曾邦雄
摘要 目的：观察麻醉前口服可乐定对体外循环期间应激反应的影响。方法：20例心脏手术病人，随机分为可乐定组与对照组。可乐定组麻醉前60分钟口服可乐定5μg*kg－1，其它麻醉前用药两组相同。分别在麻醉前、转流前、转流30、60、90和120分钟及转流停止后30分钟各采取动脉血标本，测定血浆儿茶酚胺、肾素、血管紧张素Ⅱ、血糖、血丙酮酸、血乳酸浓度。结果：血浆儿茶酚胺及血糖、丙酮酸、乳酸浓度水平在转流期间两组均明显增高，对照组明显高于可乐定组(P＜0.01)。血浆肾素及血管紧张素Ⅱ浓度可乐定组明显升高，而对照组无明显升高，两组有极显著性差异(P＜0.01)。转流期间血液动力学变化可乐定组明显比对照组平稳(P＜0.05或P＜0.01)。结论：麻醉前口服可乐定能减轻体外循环期间的应激反应。
关键词 可乐定 心肺转流术 应激反应 术前用药法
Influence of oral premedication clonidine on the stress response during cardiopulmonary bypass Shi Biming，Zeng Bangxiong．Department of Anesthesiology，Shenzhen Peoples Hospital，Shenzhen 518001
Abstract Objective：To investigate the effect of premedication with clonidine on the concentrations of plasma catecholamine（CA），renin，angiotension Ⅱ（AⅡ）and carbohydrate metabolism during cardiopulmonary bypass（CPB）．Method：Twenty patients scheduled for cardiac surgery were randomly divided into two groups：clonidine group and control group．Oral premedication with clonidine 5μg*kg－1 was taken in colndine group 60 min before anesthesia induction in addition to common same premedication in both groups．Arterial plasma concentrations of CA，renin，AⅡ，blood suger，pyruvic acid，lactic acid were measured before anesthesia，before CPB，30，60，90 and 120 min following CPB and 30 min after CPB．Result：The levels of CA，blood suger，pyruvic acid and lactic acid increased significantly during CPB in both groups，but were higher markedly in control group than those in clonidine group （P＜0．01）．Renin and AⅡ levels increased markedly in clonidine group，but remained unchanged in control group during CPB．Conclusion：Oral premedication with clonidine may attenuate stress response during CPB．
Key words Clonidine Cardiopulmonary bypass Stress Premedication
体外循环(CPB)期间应激反应强烈。血浆肾上腺素(E)、去甲肾上腺素(NE)显著升高〔1～5〕，引起严重高血压及脑卒中等危险并发症〔6〕。α２肾上腺素受体激动药可乐定能抑制中枢及外周交感神经系统活性，减轻气管插管〔7〕及CPB〔8〕引起的应激反应。本研究旨在探讨可乐定对国人在CPB期间E、NE、肾素血管紧张素的反应及对糖代谢的影响。
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