不同剂量右美托咪啶对下腹部手术患者七氟醚MACBAR的影响  

Effects of different doses of dexmedetomidine on MACBAR of sevoflurane in patients undergoing lower abdominal surgery

作　　者：付志强[1] 吕国义[1] 邓迪封[1] 

机构地区：[1]天津医科大学第二医院麻醉科,300211

出　　处：《中华麻醉学杂志》2011年第6期677-679,共3页Chinese Journal of Anesthesiology

摘　　要：目的评价不同剂量右美托咪啶对七氟醚抑制50％下腹部手术患者切皮诱发应激反应的最低肺泡气有效浓度（MACBAR）的影响。方法择期全麻下拟行下腹部手术患者60例，年龄25～55岁，体重45～75kg，ASA分级Ⅰ或Ⅱ级，采用随机数字表法，将患者随机分为对照组（Dn组，n=15）和不同剂量右美托咪啶组（D1～3，组，n=15）。D0组不使用右美托咪啶，D0组经10min静脉注射右美托咪啶0．1μg／kg负荷剂量后，分别以0．4、0．8、1．2μg·kg^-1·h^-1的速率静脉输注30min后进行麻醉诱导。D0-3，组第1例患者呼气末七氟醚浓度分别为3．0％、2．5％、2．0％、1．5％，以切皮时患者MAP或HR较基础值上升〈15％为抑制交感肾上腺反应有效，若抑制交感肾上腺反应有效则下一例呼气末七氟醚浓度降低一级，若无效则升高一级，相邻浓度比为0．9。计算七氟醚MACBAR及其95％可信区间（95%CI）。结果D0．3组七氟醚MACBAR及其95％CI分别为：2．85％（2．4.4％～3．32％）、1．91％（1．61％-2．26％）、1．52％（1．31％-1．77％）、1．34％（1．15％-1．57％）。与风组比较，D1-3组七氟醚MACBAR均降低（P〈0．05）；与D1组比较，D2组和D3组七氟醚MACBAR降低（P〈0．05）；D2组和D3组七氟醚MACBAR比较差异无统计学意义（P〉0．05）。结论右美托咪啶0．4、0．8和1．2μg·kg^-1·h^-1连续输注30min可降低七氟醚MACBAR，增强七氟醚抑制应激反应的效应，且呈剂量依赖性。Objective To investigate the effects of different doses of dexmedetomidine on the minimum alveolar concentration of sevoflurane for blunting responses to skin incision （ MACRAR ） in patients undergoing lower abdominal surgery. Methods Sixty ASA Ⅰ or Ⅱ patients, aged 25-55 yr, weighing 45-75 kg, undergoing elec- tive lower abdominal surgery under general anesthesia, were randomly divided into 4 groups （ n = 15 each） ： control group （Do group） and 3 dexmedetomidine groups （D1, 1）2 and D3 groups）. The patients were unpremedicated. Dexmedetomidine was not used in group DO . A loading dose of dexmedetomidine 0.1 μg/kg was injected iv over 10 min, and then dexmedetomidine was infused at a rate of 0.4, 0. 8 and 1.2 μg·kg^-1·h^-1for 30 rain in groups Di.3 respectively. Anesthesia was induced with inhalation of 8 % sevoflurane. Laryngeal mask airway was inserted when BIS value decreased to 45-55. The patients were mechanically ventilated with inhalation of sevoflurane and a mixture of 50% nitrous oxide and 50% oxygen, and the fresh gas flow was set at 1 L/min. In D0-3 groups, the initial end-tidal concentrations of sevoflurane were 3.0% , 2.5%, 2.0% and 1.5% respectively. The patients＇ response to skin incision was described as effective if MR or MAP increased by 〈 15 %, or ineffective （MR or MAP increased by ≥ 15% ） . When the response was effective, the end-tidal concentration of sevoflurane was decreased in the next patient, when ineffective, increased, and the ratio between the two successive concentrations was 0.9.The MRCBAR of sevoflurane was determined by up-and-down method, and 95 % confidence interval was calculated. Results The MRCBAs （95% confidence interval） of sevoflurane was 2.85% （2.44%-3.32%）, 1.91% （1.61%-2.26%）, 1.52% （1.31%-1.77%）, and 1.34% （1.15%-1.57%）in D0-3 groups respectively. The MRCBAR of sevoflurane was signitlcanfly lower in D1-3 groups than in Do group, and in D2 and D3 groups than in group Di （P 〈 0.05）. There was no significant

关 键 词：右美托咪啶 剂量效应关系 药物 应激 七氟醚 

分 类 号：R614[医药卫生—麻醉学]