预注右旋美托咪啶用于喉显微手术麻醉的临床研究  

Clinical observation of pre-injection of dexmedetomidine in anaesthesia for laryngeal microsurgery

作　　者：尚宇 康万军 李悦[2] 王兵 吕红梅 徐洪刚[3] 顾佩菲 

机构地区：[1]解放军第463医院麻醉科,沈阳市110042 [2]哈尔滨医科大学附属第一医院麻醉科 [3]辽宁医学院附属第一医院麻醉科 [4]Leiden/Amsterdam Center for Drug Research, Leiden University, the Netherlands

出　　处：《临床麻醉学杂志》2010年第5期385-387,共3页Journal of Clinical Anesthesiology

摘　　要：目的 观察预注右旋美托咪啶用于喉显微手术麻醉的临床研究.方法 78例行支撑喉镜下声带手术患者,随机均分为A、B两组,麻醉诱导前10 min分别静注右旋美托咪啶0.6 μg/kg、脂肪乳安慰剂10 ml后,采用丙泊酚2.0 mg/kg、雷米芬太尼0.5μg/kg（A组）或雷米芬太尼1.0μg/kg（B组）,琥珀胆碱1.5 mg/kg实施全凭静脉麻醉.记录和测定麻醉诱导前（T0）、插管即刻（T1）、置入支撑喉镜时（T2）、拔管后1 min（T3）、5 min（T4）的MAP、HR、去甲肾上腺素（NE）、肾上腺素（E）的变化和丙泊酚用量、麻醉恢复情况及不良反应.结果 T0、T3和T4时A组与B组比较,MAP明显下降、HR明显减慢（P〈0.05）,同时血浆NE和E浓度也明显下降（P〈0.05）;丙泊酚总用药量A组显著少于B组（P〈0.05）.A组术后咽喉疼痛、呛咳躁动、寒战的发生率也明显低于B组（P〈0.05）.结论 右旋美托咪啶0.6μg/kg可减轻应激反应、减少麻醉约用量,无呼吸抑制.Objective To investigate the effects of pre-injection of dexmedetomidine on hemodynamics and stress responses in patients undergoing laryngeal microsurgery. Methods Seventyeight patients were randomized divided into two groups with 39 cases each. Patients were intravenously injected dexmedetomidine 0. 6 μg/kg （group A）or placebo 10 ml（group B）. Anesthesia was induced with propofol 2.0 mg/kg,remfentanil 0.5（group A） or 1.0 μg/kg（group B）, scoline 1.5 mg/kg. MAP, HR and the values of norepinephrine（NE） and epinephrine（E） were detected before induction（T0 ）, intubating（T1 ）, suspensing laryngoscopy（T2）, at 1 min after extubation（T3 ） and 5 min after extubation （T4）. Propofol comsumption, anesthesia recovery and side effects were recorded as well. Results Compared to those at T0, NE, E, MAP, HR were slightly increased in both of groups at T1 ,T〉 MAP,HR and E,NE concentrations were higher in group B than those in group A at To, T3 and T4 （P〈0. 05）. Propofol consumption in group B was much more than that in group A（P〈 0. 05）. Incidence of pharynx and larynx ache, restlessness and shivering was higher in group B than those in group A（P〈0.05）. There was no significant difference in the recovery time from anesthesia between two groups. Conclusion Dexmedetomidine 0. 6μg/kg can reduce stress response to surgery and anesthetics consumption without respiratory depression.

关 键 词：右旋美托咪啶 应激反应 喉显微手术 

分 类 号：R614[医药卫生—麻醉学] R767.91[医药卫生—外科学]