右旋美托咪啶的镇静效应及其对全麻镇静深度的影响  

The effect of dexmedetomidine on sedation and anaesthetic depth in patients undergoing general anesthesia

作　　者：佘守章[1] 李慧玲[2] 许学兵[1] 莫世湟 

机构地区：[1]广州医学院附属广州市第一人民医院麻醉科,510180 [2]浙江大学医学院附属第一医院 [3]台北医科大学附属医院麻醉科

出　　处：《临床麻醉学杂志》2006年第1期10-12,共3页Journal of Clinical Anesthesiology

基　　金：广东省医学科研基金资助项目(A200571)

摘　　要：目的研究右旋美托咪啶(Dex)的镇静效应及其对全麻患者麻醉深度的影响。方法择期手术的患者60例(ASAⅠ～Ⅱ级),根据不同用药时期情况均分为镇静组和麻醉组,镇静组30例又分为Dex组(D1组)和对照组(C1组):D1组静脉泵注Dex负荷剂量0.4μg/kg(5min注完),然后以0.4μg·kg-1·h-1维持静注30min;C1组以同样方式输注生理盐水。记录不同时点的脑电双频指数(BIS)、MAP、HR,并对患者进行OAA/S、Ramesay镇静评分。麻醉组30例全麻患者也随机分为D2和C2组:D2组术中静脉Dex0.4μg/kg5min注完;C2组输注生理盐水。术中以丙泊酚靶控输注(TCI)和雷米芬太尼静脉维持麻醉,调节丙泊酚血浆靶控浓度(Ct),使BIS维持在50±3。结果D1组Dex负荷剂量输注后以及维持期间BIS比基础值降低17.0%～30.9%(P<0.05),镇静效应明显,OAA/S和Ramsay镇静评分明显降低(P<0.05);D2组患者麻醉前BIS为92±1,给予Dex后BIS由51±2降至42±16,C2组则仍为51±3。D2组丙泊酚的用量比C2组减少8%～14%(P<0.05)。结论Dex对清醒患者产生明显镇静效应,并能加深全麻患者的麻醉深度,减少丙泊酚TCI的用量。Objective To observe the effects of dexmedetomidine （Dex） on the sedation and anaesthetic depth during general anesthesia. Methods Thirty patients （ASAⅠ-Ⅱ） who were not to he in anaesthesia randomly divided into group D1 （intravenous 0.4μg·kg^-1·h^-1 Dex for 30 min after a loading dose of 0.4μg/kg） and group C1 （0.9% normal saline was given as control）. The hispectrial index （BIS）, HR, MAP, SpO2, OAA/S, Ramsay sedation scale were monitored,before Dex infusion （T0） and after loading （T1）, and at 5,10,15,20,25,30 rain （T2 -T7 ） after continuous infusion. Thirty adult patients （ASAⅠ-Ⅱ） scheduled for elective thyroidectomy were randomized double blindly into group D2 and group C2 （given drugs as in group D1 and C1）. Anesthesia was induced by target controlled infusion （TCI） with propofol and remifentanyl to maintain BIS at 50±3. Results In group D1 , BIS decreased by 17.0%-30.9% （P〈0.05） compared with that before, OAA/S and Ram say scale also decreased significantly （P〈0.05）. In group D2, administration of Dex resulted in a decrease in BIS from 51±2 to 42±16 （P〈0. 01 ）. During subsequent surgery, propofol requirements were reduced by 8%-14%（P〈20.05） in group D2. Conclusion Loading dose Dex 0.4μg/kg followed by 0. 4μg·kg^-1·h^-1 infusion caused sedation. The increase in anaesthetic depth given by Dex can be measured with BIS,increased anesthesia depth and reduced propofol requirement.

关 键 词：右旋美托咪啶 镇静 脑电双频指数 

分 类 号：R614.2[医药卫生—麻醉学]