Effect Of Dexmedetomidine On Stress Response During Endotracheal Intubation In Patients With Poorly Controlled Hypertension

Research objectives:Hypertension is the most common cardiovascular disease in general anesthesia.High stress,induction of general anesthesia,intubation stimulation and other stresses are the main factors that cause surgical hemodynamic fluctuations in patients with hypertension and lead to cardiovascular and cerebrovascular accidents.Dexmedetomidine(DEX)is a highly selective α2 adrenergic agonist with dose-dependent sedation,anti-anxiety and analgesic effects.The use of dexmedetomidine before surgery can reduce sympathetic excitability and maintain hemodynamic stability.DEX has been widely used in general anesthesia for hypertensive patients as a common anesthetic adjuvant drug,but there are few reports on the impact of hemodynamics during general tracheal intubation during general anesthesia in patients with hypertension control.This trial focused on the effects of dexmedetomidine on hemodynamic stress and other stress responses during endotracheal intubation in patients with poorly controlled hypertension.Research methods:Select top people’s hospital,180 cases of patients with surgery(ASA ～ level),Ⅱ Ⅲthe patients were divided into trial group(group D)and the control group(group C)two groups,90 cases in each group.Among them,patients in group D were divided into three subgroups: the normal blood pressure group(group e),the well-controlled hypertension group(group f)and the poorly controlled hypertension group(group g).Patients in group C were divided into three subgroups: the normal blood pressure group(group h),the wellcontrolled hypertension group(group i)and the poorly controlled hypertension group(group j).The sample size of each subgroup was 30 cases.Dexmedetomidine 0.5ug/kg(diluted to 20 mL with normal saline)was pumped 10 min before induction of general anesthesia in group D,while normal saline of the same volume was pumped in group C.After 10 min infusion,anesthesia induction was performed immediately and endotracheal intubation was completed.The anesthesia induction program was the same in the two groups.The changes of heart rate(HR)and mean arterial pressure(MAP)in patients in the two groups were observed before infusion(T0),before induction of anesthesia(T1),after induction of anesthesia(T2)and 1min(T3),3min(T4)and 5min(T5)after intubation,and the product of heart rate and systolic pressure(RPP)was calculated.Blood samples were collected at the above time points and changes in plasma concentrations of epinephrine(E)and norepinephrine(NE)were measured in the two groups.The specific experimental groups are shown in the figure: Experimental results:Through data processing and analysis,compared with T0,patients in group j in group C had significantly increased HR,MAP and RPP at T3 and T4 after endotracheal intubation(F=6.77-11.32,P<0.05),and the above indicators returned to T0 at T5(P>0.05).HR,MAP and RPP at T3～T5 were significantly lower than T0(F=7.44-10.02,P<0.05).Compared with the two groups,the HR,MAP and RPP of each subgroup in group D at T3～T5 were significantly lower than those in group j in group C(F=14.33-18.57,P<0.05).Compared with the T0 time point,the plasma NE and E levels of patients in subgroup j of group C were significantly increased at T3 and T4 time points after tracheal intubation(F=8.32-12.03,P<0.05).There was no significant increase in groups h and I,but they returned to T0 time point at T5 time point(P>0.05).For all patients in group D,plasma NE level was higher than T0 at T3(F=6.77,P<0.05),T0 at T4(P>0.05),and T0 at T5(F=9.05,P<0.05).However,there was no significant increase in plasma E level at T3(P>0.05),and it was significantly lower than T0 at T4 and T5(F=8.98,12.14,P<0.05).The plasma levels of NE and E in group D at T3～T5 were significantly lower than those in group j(F=12.56-15.44,P<0.05).Experimental conclusion:(1)endotracheal intubation during induction of general anesthesia can cause obvious stress response of the body;(2)patients with poor hypertension control had a stronger stress response to endotracheal intubation during general anesthesia induction;(3)there was no significant difference in the stress response caused by endotracheal intubation during general anesthesia induction in patients with well-controlled hypertension and those with normal blood pressure;(4)dexmedetomidine can reduce endotracheal intubation stress response;(5)compared with patients with normal blood pressure and well controlled hypertension,dexmedetomidine has a stronger inhibitory effect on stress response caused by endotracheal intubation during general anesthesia induction in patients with poor hypertension control,and such patients benefit the most.