右旋美托嘧啶对舒芬太尼-丙泊酚靶控输注效应的影响  

Effect of single dose dexmedetomidine on sufentanil.propofol target controlled infusion

作　　者：何莉[1] 佘守章[1] 阮祥才[1] 

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

出　　处：《国际麻醉学与复苏杂志》2008年第5期391-395,共5页International Journal of Anesthesiology and Resuscitation

摘　　要：目的研究预先静注小剂量右旋美托嘧啶对舒芬太尼-丙泊酚联合靶控输注效应的影响。方法选择甲状腺择期手术全麻女性患者40例（ASAⅠ～Ⅱ级），随机分成右旋美托嘧啶组（D组）和对照组（C组）两组。D组患者首先给予0．4μg/kg右旋美托嘧啶缓慢静注（5min注射完毕），C组（对照）患者给予相同方法静注生理盐水；观察10min之后开始诱导麻醉。记录给药前（T0）、给药后1min（T1）、10min（T2）、诱导后插管前（T3）、插管成功后即刻（T4）、插管后1min（T5）、3min（T6）、10min（T7）患者心率（HR）、有创动脉血压（SBP、DBP、MAP）、BIS值、OAA／S镇静评分、Ramesay镇静评分；术中每15min记录患者心率（HR）、有创动脉血压（SBP、DBP、MAP）和BIS值；观察停止麻醉后患者自主呼吸恢复时间、初醒（呼之睁眼）时间及清醒拔管时间；计算各时点RPP值（收缩压与心率的乘积）；随访术中知晓情况。结果①D组患者在静注右旋美托嘧啶后BIS值降低25．6％±4．8％（P〈0．05），OAA／S和Ramesay评分也相应下降，与T0时程相比差异有统计学意义（P〈0．05），而C组患者则无明显变化；②与T0相比，C组患者SBP、MAP、HR及RPP值在T4时刻均呈明显升高（P〈0．05）；D组无明显变化（P〉0．05）；与D组相比，在T4时刻C组SBP、HR表现出明显降低（P〈0．05）；③诱导所需丙泊酚靶浓度D组为（1．50±0．53）mg／L，C组为（2．55±0．50）mg／L，组间差异有统计学意义（P〈0．05）；D组术中所需丙泊酚靶浓度为（1．43±0．56）mg／L，C组为（2．00±0．41）mg／L，组间差异有统计学意义（P〈0．05）；④术中D组所需舒芬太尼效应室浓度为（0．15±0．5）μg/L，C组则为（0．30±0．5）μg／L，组间差异有统计学意义（P〈0．05）.结论诱导前单次静注小剂量右旋美托嘧啶可以有效抑制国人全麻诱导心血Objective To observe the effect of single dose dexmedetomidine （Dex） on sufentanil-propofol target controlled infusion. Methods Forty female patients scheduled for thyroid surgery were randomly assigned to 2 groups： dexmedtomidine group and Control group. Group D received Dex 0.4 μg/kg intravenous injection and the whole dose was given within 5 minutes. Group C （ control） received equal volume of normal saline as Group D intravenously without Dex. All other induction and maintenance drugs were same for two groups. HR, SBP, DBP, MAP, BIS, OAA/S scale and Ramesay scale were recorded at the time points of pre-administration of Dex（ T0 ）, 1 min after administration （ T1 ）, 5 min after administration （ T2 ）, pre-intubation （ T3 ）, intnbation （ T4 ）, 1 min after intubation （T5 ）, 3 min after intuhation （T6 ）, 10 min after intubation （T7 ） , and every 15 min during surgery. Each patients＇recovery of spontaneous breath, positive response to verbal command and extubation time were also recorded. Results After Dex was given, BIS scale of Group D, OAA/S scale and Ramesay scale decreased 25.6% ± 4.8% （P 〈0.05 ）. There was no obvious change in Group C（P 〉0.05）. Compared to base value, SBP, MAP, HR and RPP of Group D increased obviously with intubation（P 〈 0.05 ）, and HR remained higher 10 min after intubation （ P 〈 0. 05 ） ; Compared with Group D, SBP of Group C was lower when intubation （ P 〈 0.05 ）. Plasma concentrations of propofol at intubation were （ 1.50 ± 0.53 ） mg/L in Group D and （ 2.55 ± 0.50 ） mg/L in Group C （ P 〈 0.05 ） ; while during surgery, they were （ 1.43 ± 0.56） mg/L and （2.00 ± 0.41 ） mg/L respectively （ P 〈 0.05 ）. Concentrations of sufentanil during surgery were （0.15 ± 0.5 ） μg/L in Group D and （0.30 ±0.5 ） μg/L in Group C （P 〈 0.05 ）. Conclusion A single dose of Dex given intravenously before induction can suppress cardiovascular response of Chinese in intubation and surgery and

关 键 词：舒芬太尼 丙泊酚 靶控输注 右旋美托嘧啶 全凭静脉麻醉 

分 类 号：R614[医药卫生—麻醉学]