右美托咪定对下腹部手术患者异氟醚呼气末有效浓度的影响  

Effects of dexmedetomidine on end-tidal isoflurane concentration in patients undergoing lower abdominal surgery

作　　者：高鲜丽[1] 王世端[1] 江岩[1] 徐红梅[1] 牛泽军[1] 

机构地区：[1]青岛大学医学院附属医院麻醉科,青岛市266003

出　　处：《临床麻醉学杂志》2012年第3期228-230,共3页Journal of Clinical Anesthesiology

摘　　要：目的以脑电双频指数(BIS)为麻醉镇静深度指标,探讨右美托咪定(Dex)的不同输注速率对下腹部手术患者异氟醚呼气末有效浓度的影响。方法妇科剖腹手术患者60例,ASAⅠ或Ⅱ级,随机均分为:生理盐水对照组(C组),Dex 0.4μg/kg组(D_1组):Dex负荷量0.4μg/kg+维持量0.4μg·kg^(-1)·h^(-1),Dex 0.8μg/kg组(D_2组):Dex负荷量0.8μg/kg+维持量0.8μg·kg^(-1)·h^(-1)。三组负荷量药物均以微量泵于麻醉诱导前在10 min内泵注完毕。麻醉诱导:静注丙泊酚1～3mg/kg、芬太尼3μg/kg、维库溴铵0.12 mg/kg,当BIS<55时行气管插管。术中根据BIS值变化调节异氟醚吸入浓度维持BIS在40～55。术中持续监测血流动力学变化、异氟醚吸入和呼气末浓度。结果术中及术毕D_1、D_2组异氟醚呼气末浓度均明显低于C组(P<0.05或P<0.01),且D_2组明显低于D_1组(P<0.05)。与C组比较,气管插管及拔管时D_1组及D_2组血流动力学更稳定。结论以BIS值为监测标准,Dex能有效降低异氟醚呼气末浓度,提高围术期血流动力学稳定性,未见严重不良反应。Objective To investigate the effects of dexmedetomidine on end-tidal isoflurane concentration with bispectral index （BIS） as the index of depth of anesthesia. Methods Sixty patients undergoing elective lower abdominal surgery received general anesthesia, ASA I or II, were randomly divided into three groups： group C received a saline infusion, group D1 received Dex loading 0.4μg/kg for 10 min,maintenance 0.4μg.kg-1 .h-1 ; group D2 received Dex loading 0. 8μg/kg for 10 min, maintenance 0. 8 μg · kg-1 ·h-1. And then intravenous injection of propofol 1-3 mg/kg, fentanyl 3μg/kg and vecuronium 0. 12 mg/kg. When the BIS〈 55, patients were received tracheal intubation and mechanical ventilation. The concentration of isoflurane was adjusted according to BIS. HR, MAP and end-tidal isoflurane concentation were continuously monitored. Results When BIS was maintained between 40 and 55, the end-tidal isoflurane concentration of group D1 and group I）z were lower than that in group C（P〈0.05 or P〈0. 01）, and group D2 were lower than group D1 （P〈 0.05）. Compared with group C, group D1 and group D2 were able to well-control MAP and HR fluctuations caused by tracheal intubation and extubation. Conclusion Adjunctive use of an intraoperative Dex decreased end-tidal isoflurane concentration, promoted hemodynamic stability, and no severe adverse effectswas observed.

关 键 词：DEX 异氟醚 吸入麻醉 

分 类 号：R614[医药卫生—麻醉学]