右美托咪啶和异丙酚用于难治性精神病患者脑立体定向手术麻醉效果的比较  

Comparison of dexmedetomidine and propofol for stereotactic brain surgery in patients with intractable psychosis

作　　者：王高翔[1] 张莲花[1] 赵晖[1] 王瑗[1] 孙绪德[1] 

机构地区：[1]第四军医大学唐都医院麻醉科,西安市710038

出　　处：《中华麻醉学杂志》2012年第6期749-751,共3页Chinese Journal of Anesthesiology

摘　　要：目的比较右美托咪啶和异丙酚用于难治性精神病患者脑立体定向手术的麻醉效果。方法拟行立体定向脑内多靶点射频毁损术的难治性精神病男性患者30例，年龄22～33岁，体重60-90kg，采用随机数字表法，将其随机分为2组（n=15）：异丙酚组（P组）和右美托咪啶组（D组）。麻醉诱导：2组均静脉注射咪达唑仑0．05～0．10mg／kg和芬太尼1～2μg／kg。D组静脉输注右美托咪啶负荷量1μg／kg（输注时间〉10min），随后以0．3～0．7μg·kg^-1·h^-1速率输注，气管插管前，静脉注射异丙酚1～2mg／kg。P组静脉注射异丙酚2～3mg／kg，随后以3～4mg·kg^-1·h^-1速率静脉输注。经口直接喉镜引导气管插管，保留自主呼吸。分别记录定位过程中体动、呛咳、呼吸暂停、心血管不良事件和低氧血症等的发生情况。结果与P组比较，D组体动、呛咳、呼吸暂停、心动过速、低血压和低氧血症的发生率降低，心动过缓的发生率升高（P〈0．01），高血压发生率差异无统计学意义（P〉0．05）。结论与异丙酚麻醉比较，右美托咪啶用于难治性精神病患者脑立体定向手术时麻醉效果好，且对呼吸及循环功能的影响小，更安全。Objective To compare the effects of dexmedetomidine and propofol for stereotactic brain surgery in patients with intractable psychosis. Methods Thirty male patients with intractable psychosis, aged 22-33 yr, weighing 60-90 kg, scheduled for stereotactic surgery, were randomized to receive either propofol （group P, n = 15） or dexmedetomidine （group D, n = 15）. Anesthesia was induced with iv injection of midazolam 0.05-0.10 mg/kg and fentany 1-2 μg/kg in the two groups, and in addition, dexmedetomidine was infused at 0.3-0.7 μg· kg^-1 . h^-1 after a loading dose of 1μg/kg （duration of infusion 〉 10 min） and propofol 1-2 mg/kg was injected intravenously before endotracheal intubation in group D and propofol 2-3 mg/kg was injected intravenously and then propofol was infused at a rate of 3-4 mg·kg^-1 · h^-1 in group P. Orotracheal intubation was performed under the guidance of direct laryngoscope. The patients kept spontaneous breathing. The adverse events such as body movement, bucking, apnea, adverse cardiac events and hypoxemia were recorded during location. Results The incidence of body movement, bucking, apnea, tachycardia, hypotension and hypoxemia was significantly lower, while the incidence of bradycardia was significantly higher in group D than in group P （ P 〈 0.01 ）. There was no significant difference in the incidence of hypertension between the two groups （ P 〉 0.05 ）. Conclusion Dexmedetomidine provides better anesthesia, exerts less effect on the respiratory and Circulatory functions and is safer than propofol for stereotactic surgery in patients with intractable psychosis.

关 键 词：右美托咪啶 二异丙酚 麻醉 全身 立体定位技术 

分 类 号：R614[医药卫生—麻醉学]