经手术期间注射德克斯梅德托米丁对腹腔内切除术期间血液动力稳定性的影响:一项随机研究
Youngwon Kim1, Young Chul Yoo1, Na Young Kim1
1Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Frontiers in medicine
|November 29, 2023
概括
经手术内使用的德克斯梅德托米丁可以通过降低血压和心率来改善腹腔镜上腺切除过程中的血液动力稳定性. 这项研究强调了其在治疗这种罕见的神经内分泌瘤方面的潜在益处.
科学领域:
- 麻醉学和外科手术期间的医学.
- 内分泌学和新陈代谢学
- 手术瘤学手术瘤学
背景情况:
- 染细胞瘤是一种罕见的神经内分泌瘤,由上腺髓的染色蛋白细胞产生的,导致甲基荷胺的过度生产.
- 患有染细胞瘤的患者在麻醉诱导和手术操纵期间面临血动力学不稳定的重大风险.
- laparoscopic adrenalectomy 是一种常见的手术方法,用于 pheochromocytoma,需要谨慎的血液动力学管理.
研究的目的:
- 为了研究手术内用德克斯梅德托米丁在腹腔镜上除术期间维持血液动力稳定性的疗效.
- 评估德克斯梅德托米丁对手术期间血压和心率波动的影响.
- 为了评估与德克斯梅托米丁使用的血甲基胺度 (上腺素和上腺素) 的变化.
主要方法:
- 这是一项随机对照试验,涉及40名接受腹腔镜上腺切除术的患者.
- 患者被分配给接受德克斯梅德托米丁 (n=20) 或对照 (n=20) 输液.
- 主要结局:手术期间血液动力学稳定性. 二级结局:血中甲基胺含量.
主要成果:
- 与对照组相比,德克斯梅德托米丁组的手术内静脉压,腹静脉压和平均血压显著降低 (p < 0.05).
- 在手术期间的最大心率在德克斯梅德托米丁组显著降低 (p=0.010).
- 两组之间没有观察到血上腺和北上腺的度有显著差异.
结论:
- 在手术内输注德克斯梅德托米丁 (0.5微克/千克/小时) 有效地减轻了手术内最大血压和心率,这些患者接受了 laparoscopic adrenalectomy 为 pheochromocytoma.
- 德克斯梅德托米丁的使用有助于改善该患者群体的血液动力稳定性.
- 进一步的研究可能会探索最佳剂量和长期结果.
相关概念视频
Adrenergic Agonists: Therapeutic Uses
797
Adrenergic agonists have diverse therapeutic uses across various medical conditions and emergencies.
Emergency and Intensive Care Unit (ICU) applications: Pressor agents increase blood pressure, heart rate, and contractility in shock and organ failure situations. Dopamine can induce vasodilation and stimulate adrenoceptors. Endogenous catecholamines are effective in treating cardiogenic shock. α2-agonists like clonidine can reverse anesthesia-induced hypertension.
Allergies and...
Emergency and Intensive Care Unit (ICU) applications: Pressor agents increase blood pressure, heart rate, and contractility in shock and organ failure situations. Dopamine can induce vasodilation and stimulate adrenoceptors. Endogenous catecholamines are effective in treating cardiogenic shock. α2-agonists like clonidine can reverse anesthesia-induced hypertension.
Allergies and...
797
Parenteral Anesthetics: Overview
130
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
130
Skeletal Muscle Relaxants: Adverse Effects
375
Skeletal muscle relaxants are widely used for muscle paralysis and relieving pain following any muscle injury or stiffness. However, depending on the drug type, they can have adverse effects that range from mild to severe. Usually, nondepolarizing neuromuscular blockers have minimal side effects. For example, drugs like d-tubocurarine, cisatracurium, and rocuronium cause hypotension, whereas drugs like baclofen, when stopped abruptly, can lead to the recurrence of spastic conditions.
Unlike...
Unlike...
375
Depolarizing Blockers: Pharmocokinetics
328
Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
328
Cardiac Catheterization IV: Nursing Management
25
Nursing responsibilities before cardiac catheterization include:Assess for allergies and establish baseline health status.Before cardiac catheterization, assess the patient for allergies to contrast dye. Perform a comprehensive baseline assessment, including vital signs, heart and breath sounds, and a neurovascular assessment of the extremities, noting distal pulses, skin color, and temperature. Instruct the patient to fast for 8-12 hours before the procedure. Evaluate baseline laboratory...
25
Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers
747
Adrenergic stimulation generally impacts cardiac rate and rhythm. Specifically, stimulation of the β-adrenoceptors triggers an increase in intracellular calcium ion influx and pacemaker currents, which may cause arrhythmias. Catecholamines like adrenaline also demonstrate β2-adrenoceptor-mediated hypokalemia, impacting cardiac action potential and disrupting the normal cardiac rhythm. Class II antiarrhythmic drugs are β-adrenoceptor antagonists or β-blockers, which...
747


