静脉注射与肌肉注射可乐定对腹腔镜胆囊切除术中血流动力学变化抑制作用的比较评估
The comparative evaluation of intravenous with intramuscular clonidine for suppression of hemodynamic changes in laparoscopic cholecystectomy.
作者信息
Singh Meena, Choudhury Arin, Kaur Manpreet, Liddle Dootika, Verghese Mary, Balakrishnan Ira
机构信息
Department of Anaesthesia and Critical Care, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
出版信息
Saudi J Anaesth. 2013 Apr;7(2):181-6. doi: 10.4103/1658-354X.114070.
BACKGROUND
Clonidine diminishes stress response by reducing circulating catecholamines and hence increases perioperative circulatory stability in patients undergoing laparoscopic surgeries. The aim of this study was to compare intravenous (IV) clonidine (2 μg/kg) with intramuscular (IM) clonidine (2 μg/kg) for attenuation of stress response in laproscopic surgeries.
METHODS
Eighty adult patients classified as ASA physical status I or II, aged between 20 and 60 years undergoing elective cholecystectomy under general anesthesia were enrolled for a prospective, randomized, and double-blind controlled trial. They received either IV clonidine (2 μg/kg) 15 min prior to the scheduled surgery (Group I) or IM clonidine (2 μg/kg) 60-90 min prior to the scheduled surgery (Group II). Hemodynamic variables (Heart rate, systolic (SBP), diastolic (DBP), mean arterial pressure (MAP)), SpO2 and EtCO2 were recorded at specific times - baseline, prior to induction, 1 min after intubation, before CO2, insufflation, after CO2 insufflation at 1,5,10,20,30,45,60 min, after release of CO2, at 1 and 10 minutes after extubation. Secondary outcomes included evaluation of adverse effect profile of the two groups.
RESULTS
No significant difference was observed in the HR throughout the intraoperative period in between the two groups (P>0.05). There was statistically significant difference in SBP between the two groups starting from 1 minute after induction till 1 min after extubation (P<0.05) but not in DBP except at 1 minute after intubation (P=0.042). Significant difference in MAP was noted at 1 minute after intubation (P=0.004) and then from 5 minutes after CO2 insufflation to 1 minute after extubation (P<0.05). Incidence of adverse effects were higher in group II (P=0.02) especially incidence of hypertension requiring treatment (0.006).
CONCLUSION
We conclude that under the conditions of this study, hemodynamic parameters (SBP, DBP and MAP) were better maintained in the IV as compared to the IM route that had significantly higher incidence of hypertension requiring treatment.
背景
可乐定通过减少循环中的儿茶酚胺来减轻应激反应，从而提高接受腹腔镜手术患者的围手术期循环稳定性。本研究的目的是比较静脉注射（IV）可乐定（2μg/kg）和肌肉注射（IM）可乐定（2μg/kg）对腹腔镜手术应激反应的减轻作用。
方法
八十名年龄在20至60岁之间、ASA身体状况为I或II级、在全身麻醉下接受择期胆囊切除术的成年患者被纳入一项前瞻性、随机、双盲对照试验。他们在预定手术前15分钟接受静脉注射可乐定（2μg/kg）（第一组）或在预定手术前60 - 90分钟接受肌肉注射可乐定（2μg/kg）（第二组）。在特定时间记录血流动力学变量（心率、收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP））、SpO2和EtCO2——基线、诱导前、插管后1分钟、二氧化碳气腹前、二氧化碳气腹后1、5、10、20、30、45、60分钟、二氧化碳释放后、拔管后1和10分钟。次要结果包括评估两组的不良反应情况。
结果
两组在整个术中期间心率无显著差异（P>0.05）。从诱导后1分钟到拔管后1分钟，两组收缩压有统计学显著差异（P<0.05），但舒张压除插管后1分钟外无显著差异（P = 0.042）。插管后1分钟平均动脉压有显著差异（P = 0.004），然后从二氧化碳气腹后5分钟到拔管后1分钟有显著差异（P<0.05）。第二组不良反应发生率更高（P = 0.02），尤其是需要治疗的高血压发生率（0.006）。
结论
我们得出结论，在本研究条件下，与肌肉注射途径相比，静脉注射途径能更好地维持血流动力学参数（收缩压、舒张压和平均动脉压），而肌肉注射途径中需要治疗的高血压发生率显著更高。
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