右旋美托咪啶的镇静效应及其对国人颈内动脉血流量的影响  

The influence of low dose dexmedetomidine on sedation and internal carotid artery blood flow in Chinese

作　　者：佘守章[1] 许学兵[1] 李慧玲[1] 吴戴红[2] 莫世湟 

机构地区：[1]广州医学院附属市一人民医院麻醉科,广州510180 [2]广州医学院附属市一人民医院功能影像科,广州510180 [3]台北医科大学附属医院麻醉科

出　　处：《广东医学》2005年第6期729-732,共4页Guangdong Medical Journal

基　　金：广东省医学科学技术研究基金资助项目(A2002573)

摘　　要：目的研究右旋美托咪啶(dexmedetomidine,Dex)的镇静效应及其对国人颈内动脉血流量的影响。方法选择30例年青患者(ASAⅠ～Ⅱ)随机分为两组,各15例,Dex镇静组(D组)和对照组(C组),D组输注负荷剂量Dex0.4μg/kg(5min内)后以0.4μg/(kg·h)维持30min,C组输注生理盐水对照。监测所有患者的脑电双频谱指数(BIS)、听觉诱发电位指数(A-lineARXIndex,AAI)、MAP、HR、SpO2、PETCO2、OAA/S和Ramsay镇静评分,并采用AU4型彩色多普勒仪测量颈总动脉、颈内动脉内径、血流速率、血流量。连续记录基础值(T0),负荷剂量后即刻(T1),以及持续泵注Dex后5,10,15,20,25,30min(T2～7)上述各项指标。结果Dex负荷剂量输注后以及维持期间,镇静效应明显,BIS和AAI比基础值分别降低17.0%～30.9%(P<0.05)及30.1%～43.4%(P<0.05);OAA/S和Ramsay镇静评分也明显降低(P<0.05)。Dex负荷量输注后患者颈总动脉血流速率、血流量先明显增加(P<0.05)后逐渐回落;持续输注25min后患者颈内动脉血流速率、血流量比基础值降低17%～21%(P<0.05);期间患者HR和MAP与比基础值均引起无临床意义的降低(P<0.05);所有患者无明显呼吸抑制。结论Dex负荷剂量0.4μg/kg继以0.4μg/(kg·h)维持输注对国人产生明显镇静,同时减少颈内动脉的血流量。Objective To observe the influence of low dose dexmedetomidine(Dex) on sedation and internal carotid artery blood flow in Chinese. Methods Thirty young healthy patients(ASA Ⅰ～Ⅱ) were randomly divided into 2 group: Dexmedetomidine group(Group D, n=15) or control group(Group C, n=15). In Group D, 0.4 (μg/(kg·h)) intravenous dexmedetomidine was maintained for 30 minutes after a loading dose of 0.4 (μg/kg) of dexmedetomidine given in 5 minutes. In Group C, 0.9% normal saline was given as control. The MAP, HR, SpO_2, P_(ET)CO_2, Bispectral Index (BIS), A-line ARX Index (AAI), OAA/S scale, Ramsay sedation scale were monitored,and the basic diameter, blood flow velocity, blood flow of common carotid artery and internal carotid artery were measured with AU_4 color Doppler. The above parameters were recorded at the time before dexmedetomidine infusion(T_0), after loading dose(T_1), and 5, 10, 15, 20, 25, 30 minutes(T_(2～7)) after continuous infusion. Results Demographic data of the patients in both groups were comparable. Afte dexmedetomidine loading dose was given and during continuous infusion, BIS and AAI decreased by 17.0%～30.9% and 30.1%～43.4%(P<0.05) compared with basic value respectively. OAA/S and Ramsay scale also decreased significantly(P<0.05), which showed an obvious sedative effects of Dex. The blood flow velocity, blood flow of common carotid artery increased(P<0.05) and subseqnently return back to normal after the loading dose of Dex. The blood flow velocity and blood flow of the internal carotid artery decreased by 17%～21%(P<0.05)at T_5 and T_6 compare with T_0. Dexmedetomidine infusion also produced HR and MAP decrease of 15.2% and 19.8% respectively(P<0.05). However, the change in HR and MAP was not clinically significant. No respiratory depression was observed. Conclusion Low dose dexmedetomidine 0.4 (μg/kg) loading dose followed by 0.4 (μg/(kg·h)) continuous infusion causes sedation and decreases the blood flow of internal carotid artery.

关 键 词：右旋美托咪啶 动脉血流量 镇静效应 Ramsay镇静评分 听觉诱发电位指数 脑电双频谱指数 负荷剂量 生理盐水对照 PETCO2 彩色多普勒仪 血流速率 颈总动脉 颈内动脉 Dex Index 方法选择 SpO2 动脉内径 持续泵注 持续输注 临床意义 

分 类 号：R971.93[医药卫生—药品] R745.12[医药卫生—药学]