不同剂量右美托咪啶复合异丙酚和瑞芬太尼用于腹部手术病人麻醉的效果  

Efficacy of anesthesia with different doses of dexmedetomidine combined with propofol and remifentanil in patients undergoing abdominal surgery

作　　者：李坤河[1] 李毅[1] 舒海华[1] 江楠[1] 陈祯[1] 肖亮灿[1] 

机构地区：[1]中山大学附属第一医院麻醉科,广州市510080

出　　处：《中华麻醉学杂志》2012年第7期799-801,共3页Chinese Journal of Anesthesiology

摘　　要：目的评价不同剂量右美托咪啶复合异丙酚和瑞芬太尼用于腹部手术病人麻醉的效果。方法择期拟在全麻下行腹部手术病人90例，性别不限，年龄18～64岁，体重45～80kg，ASA分级Ⅰ或Ⅱ级，采用随机数字表法，将其随机分为3组（n=30）。对照组（C组）静脉输注生理盐水10ml／h；右美托咪啶0．25μg·kg-1·h-1组（D。组）和右美托咪啶0．50μg·kg-1·h-1组（D：组）于15min内静脉输注右美托咪啶负荷剂量0．5μg／kg，然后分别以0．25μg·kg-1·h-1或的0．50μg·kg-1·h-1速率静脉输注至拔除气管导管。麻醉诱导：TCI异丙酚，血浆靶浓度1．0μg／mJ，静脉注射顺阿曲库铵0．2mg／kg，TCI瑞芬太尼，血浆靶浓度3rig／m1，气管插管后行机械通气。麻醉维持：TCI瑞芬太尼，血浆靶浓度5ng／ml，静脉输注顺阿曲库铵0．1mg·kg-1·h-1，TCI异丙酚，调节其血浆靶浓度，维持Narcotrend指数37～46。记录术中瑞芬太尼、顺阿曲库铵和异丙酚的用量、气管导管拔除时间和苏醒时间、术中和麻醉恢复期不良反应的发生情况。结果3间瑞芬太尼、顺阿曲库铵的用量和气管导管拔除时间差异无统计学意义（P〉0．05）；与C组比较，D，组和D：组苏醒时间延长，术中高血压、心动过速和麻醉恢复期烦躁、呕吐、高血压、心动过速的发生率降低，D2组异丙酚用量减少（P〈0．05）；与D，组比较，D2组苏醒时间延长，术中高血压和麻醉恢复期烦躁、心动过速和高血压的发生率降低（P〈0．05）。结论复合异丙酚和瑞芬太尼时，静脉输注右美托咪啶0．50μg·kg-1·h-1用于腹部手术病人麻醉的效果较好。Objective To evaluate the efficacy of anesthesia with different doses of dexmedetomidine combined with propofol and remifentanil in patients undergoing abdominal surgery. Methods Ninety ASA I or II patients of both sexes, aged 18-64 yr, weighing 45-80 kg, undergoing abdominal surgery, were randomly assigned into 3 groups （ n = 30 each） ： control group （group C） , dexmedetomidine 0.25 μg·kg-1·h-1 group （group DI ） and dexmedetomidine 0.50 /μg·kg-1·h-1 group （ group D2 ） . Dexmedetomidine was infused at a rate of 0.25 μg·kg-1·h-1 and 0.50 μg·kg-1·h-1 in groups D1 and D2 respectively until extubation after a loading dose of 0.5 μg/kg over 15 min. In group C, normal saline was infused intravenously at a rate of 10 ml/h. Anesthesia was induced with TCI of propofol with the target plasma concentration （Cp） of 1.0 μg/ml, iv injection of cisatracurium 0.2 mg/kg and TCI of remifentanil with Cp of 3 ng/ml. The patients were tracheal intubated and mechanically ven- tilated. PrT COs was maintained 35-40 mm Hg and SpO2 was maintained ≥ 95 % . Anesthesia was maintained with TCI of remifentanil with the target Cp of 5 ng/ml, iv infusion of cisatracurium 0.1 mg·kg-1·h-1 and TCI of propofol. The target Cp of propofol was increased to maintain Narcotrend index of 37-46. The amount of remifentanil,cisatracurium and propofol consumed, extubation time and eye-opening time,complications during operation and during recovery from anesthesia were recorded. Results There was no significant difference in the amount of remifentanil and cisatracurium consumed and extubation time among the three groups （ P 〉 0.05）. Compared with group C, the eye-opening time was significantly prolonged, the incidence of hypertension and tachycardia during operation, and restlessness, vomitting, hypertension, and tachycardia during recovery from anesthesia was significantly decreased in groups D1 and D2 , and the amount of propofol consumed was significantly decreased in group D2 （ P 〈 0.05）. Compared with gr

关 键 词：右美托咪啶 二异丙酚 哌啶类 麻醉 静脉 

分 类 号：R614[医药卫生—麻醉学]