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摘要：
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摘要：目的 探讨全凭静脉麻醉复合不同剂量右美托咪定（dexmedetomidine，DEX）对肝硬化患者围术
期应激反应和苏醒质量的影响。方法 选取2016年6月至2017年5月于首都医科大学附属北京地坛医院行
开腹脾切除+贲门食管下端血管离断术的87例肝硬化患者为研究对象。根据随机数字表法将患者分为
D0组（21例）、D1组（22例）、D2组（22例）和D3组（22例）。D1、D2、D3组患者依次经外周静脉
持续泵注0.1 μg /（kg·h）、0.3 μg /（kg·h）和0.5 μg /（kg·h）DEX，D0组患者泵注等量生理盐水作为对
照，15分钟后开始麻醉诱导。分别在麻醉诱导前（T 0 ）、插管后1分钟（T 1 ）、插管后5分钟（T 2 ）、
切皮时（T 3 ）、手术开始30分钟时（T 4 ）、拔管即刻（T 5 ）和拔管后5分钟（T 6 ）测定各组患者血清肾
上腺素（adrenalin，ADR）水平及平均动脉压（mean arterial pressure，MAP）。对比各组患者麻醉和
手术过程中的不良反应，在拔管后10分钟进行镇静-躁动评分（SAS评分）和Ramsay镇静评分。结果
D0、D1组患者T 1 、T 3 、T 5 时的MAP水平较T 0 时升高，D2、D3组患者T 1 、T 3 、T 5 时的MAP水平显著低于
D0组患者，D3组患者T 1 、T 5 时的MAP水平显著低于D2组患者，差异均有统计学意义（P均＜ 0.05）。
D1、D2、D3组患者的ADR在T 1 、T 3 、T 5 时均显著低于D0组患者（P ＜ 0.05），且ADR随DEX使用剂
量的增加而逐渐降低。D0、D1、D2组患者低血压和心动过缓发生率显著低于D3组（P ＜ 0.05）。
D1、D2、D3组患者拔管后10分钟的SAS评分均显著低于D0组，Ramsay镇静评分均显著高于D0组（P
均＜ 0.05），SAS评分随DEX使用剂量的增大而逐渐降低，Ramsay镇静评分随DEX使用剂量的增加而
逐渐升高。结论 肝硬化患者接受开腹脾切除+贲门食管下端血管离断术时，持续应用0.3 μg /（kg·h）
DEX可较好地维持患者循环稳定，降低围术期的应激反应，减少全麻用药量及不良反应的发生，改善
患者苏醒质量，提高手术安全性。
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Abstract: Objective To investigate the effects of intravenous anesthesia combined with different doses
of dexmedetomidine (DEX) on perioperative stress response and wakefulness in patients with liver
cirrhosis. Methods A total of 87 patients with liver cirrhosis who underwent laparotomy splenectomy and
devascularization of the lower end of esophagus in Beijing Ditan Hospital, Capital Medical University from
June 2016 to May 2017 were selected and divided into D0 group (21 cases), D1 group (22 cases), D2 group
(22 cases) and D3 group (22 cases) according to the random number table method. Patients in D1, D2 and D3
groups were continuously pumped with 0.1 μg / (kg·h), 0.3 μg / (kg·h) and 0.5 μg / (kg·h) DEX, respectively,
while patients in D0 group were pumped with the same amount of saline as controls, the induction of
anesthesia began after 15 minutes. The serum adrenaline (ADR) level and mean arterial pressure (MAP) of
patients in each group were measured before anesthesia induction (T0), 1 min after intubation (T1), 5 min
after intubation (T2), skin incision (T3), 30 min after surgery (T4), extubation time (T5) and 5 min after
extubation (T6), respectively. The incidence during the operation were compared among the four groups.
The sedation-agitation score (SAS) and Ramsay sedation score were also measured 10 min after extubation.
Results The MAP levels of patients in D0 and D1 group increased significantly at T 1 , T 3 and T 5 compared
with those at T 0 , which decreased significantly at T 1 , T 3 and T 5 in D2 and D3 group compared with those
in D0 group (P ＜ 0.05). The MAP levels of patients in D3 group at T 1 and T 5 were lower than those in D2
group, the differences were statistically significant (P ＜ 0.05). The ADR of patients in D1, D2 and D3 groups
at T 1 , T 3 and T 5 decreased significantly compared with those in D0 group (P ＜ 0.05). The ADR decreased
with the increase of DEX dosage. The incidence rates of hypotension and bradycardia of patients in D0, D1
and D2 group were lower than those in D3 group (P ＜ 0.05). The SAS scores of patients in D1, D2 and D3
group at 10 min after extubation were lower than those in D0 group (P ＜ 0.05), and the Ramsay sedation
scorers of patients in D1, D2 and D3 group at 10 min after extubation were higher than those in D0 group (P ＜
0.05). The SAS score decreased and Ramsay sedation scorers increased with the increase of the DEX dosage.
Conclusions For patients with liver cirrhosis who underwent laparotomy splenectomy and devascularization
of the lower end of esophagus, continuous application of 0.3 μg / (kg·h) DEX could maintain the circulatory
stability, reduce the perioperative stress response as well as general anesthesia medication and adverse
reactions, moreover, it can also improve the wakefulness of the patients and the safety of surgery.
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