标题：右美托咪定联合氯胺酮靶控输注对高血压患者腹腔镜胆囊切除术血流动力学的影响

      作者：陈佩军 1，李法印 2，彭慧 3    (1.盐城市第六人民医院麻醉科，江苏 盐城 224000；2.南京医科大学附属淮安第一医院麻醉科，江苏 淮安 223300；3.南京医科大学第二附属医院麻醉科，江苏 南京 210011)

      卷次： 2018年29卷18期

      【摘要】 目的 探讨右美托咪定联合氯胺酮靶控输注对高血压患者腹腔镜胆囊切除术血流动力学的影响。方法 选择2016年1月至2017年8月在盐城市第六人民医院行腹腔镜下胆囊切除术的高血压患者50例，采用随机数表法分为右美托咪定联合氯胺酮组(DK组)和生理盐水组(NS组)，每组25例。DK组患者术前15 min按照2 ng/mL血浆靶浓度输注右美托咪定，手术开始前按照100 ng/mL血浆靶浓度输注氯胺酮；NS组在相同时间点输注相同体积生理盐水。记录麻醉前(T0)、气管插管时(T1)、气腹时(T2)、拔管时(T3)、苏醒后30 min (T4)的心率(HR)、收缩压(SBP)、舒张压(DBP)等血流动力学指标；监测并记录两组患者术中、术后并发症发生情况。结果 NS组和DK组患者T1时SBP [(162.1±14.8) mmHg vs (148.6±12.6) mmHg]、DBP [(76.7±13.8) mmHg vs (69.5±11.2) mmHg]及HR [(82.8±9.9)次/min vs(72.3±12.6)次/min]相比较，T2时 SBP [(170.3±12.5) mmHg vs (161.5±10.1) mmHg]、DBP [(85.2±12.1) mmHg vs(76.7±14.2) mmHg]相比较，T3时 SBP [(154.4±13.2) mmHg vs (147.5±14.0) mmHg]、DBP [(77.0±13.5) mmHg vs(69.3±12.0) mmHg]及HR [(78.1±10.1)次/min vs (73.4±11.1)次/min]相比较，NS组均明显高于DK组，差异均有统计学意义(P<0.05)；NS组患者术中高血压发生率为44.0%，明显高于DK组的12.0%，差异有统计学意义(P<0.05)。结论 右美托咪定联合氯胺酮靶控输注可减轻高血压患者腹腔镜胆囊切除术中、术后的血流动力学变化，减少并发症的发生。
      【关键词】 右美托咪定；氯胺酮；靶控输注；腹腔镜胆囊切除术
      【中图分类号】 R544.1 【文献标识码】 A 【文章编号】 1003—6350（2018）18—2548—04

Effect of target-controlled infusion of dexmedetomidine combined with ketamine on haemodynamics inhypertensive patients undergoing laparoscopic cholecystectomy.
CHEN Pei-jun 1, LI Fa-yin 2, PENG Hui 3. 1.Department of Anesthesiology, Yancheng Sixth People's Hospital, Yancheng 224000, Jiangsu, CHINA; 2. Department ofAnesthesiology, the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian 223300, Jiangsu,CHINA; 3. Department of Anesthesiology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011,Jiangsu, CHINA
【Abstract】 Objective To explore the effect of target-controlled infusion of dexmedetomidine combined withketamine on haemodynamics in hypertensive patients undergoing laparoscopic cholecystectomy. Methods A total of50 hypertensive patients undergoing laparoscopic cholecystectomy in Yancheng Sixth People's Hospital from Jan. 2016to Aug. 2017 were randomly and equally allocated into two groups (n=25 each): dexmedetomidine combined with ket-amine group (group DK) and saline group (group NS). In group DK, patients received dexmedetomidine infusion at tar-get plasma concentration of 2 ng/mL 15 minutes before operation, followed by ketamine infusion at target plasma con-centration of 100 ng/mL before operation. Patients in group NS received the same volume of saline. Heart rate, systolicpressure and diastolic pressure were monitored and recorded before anesthesia (T0) and at the time points of intubation(T1), pneumoperitoneum (T2), extubation (T3) and 30 minutes after recovery (T4). In addition, intraoperative and post-operative complications were recorded. Results At T1, SBP, DBP and HR in group NS were significantly higher thanthose in group DK (P<0.05): (162.1±14.8) mmHg vs (148.6±12.6) mmHg, (76.7±13.8) mmHg vs (69.5±11.2) mmHg,(82.8±9.9) beats/min vs (72.3±12.6) beats/min. At T2, SBP and DBP in group NS were significantly higher (P<0.05):(170.3±12.5) mmHg vs (161.5±10.1) mmHg, (85.2±12.1) mmHg vs (76.7±14.2) mmHg. At T3, SBP, DBP and HR ofgroup NS were significantly higher (P<0.05): (154.4±13.2) mmHg vs (147.5±14.0) mmHg, (77.0±13.5) mmHg vs (69.3±12.0) mmHg, (78.1±10.1) beats/min vs (73.4±11.1) beats/min. Incidence of intraoprative hypertension was decreased sig-nificantly in group DK as compared with group NS: 12.0% vs 44.0%. Conclusion Target-controlled infusion of dexme-detomidine combined with ketamine could depress the change of haemodynamics and decrease the incidence of compli-cations in hypertensive patients undergoing laparoscopic cholecystectomy.
      【Key words】 Dexmedetomidine; Ketamine; Target-control infusion; Laparoscopic cholecystectomy·论 著·doi:10.3969/j.issn.1003-6350.2018.18.010