右美托咪定对妇科腹腔镜手术患者Narcotrend指数与丙泊酚用量的影响  

Effects of Dexmedetomidine on Narcotrend Index and Propofol Requirement of Patients Undergoing Gynecological Laparoscopic Surgery

作　　者：何超[1] 罗爱林[1] 刘九红[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院麻醉学教研室,武汉430030

出　　处：《医药导报》2012年第9期1138-1142,共5页Herald of Medicine

摘　　要：目的观察右美托咪定(Dex)对全麻下妇科腹腔镜手术患者Narcotrend指数(NTI)及丙泊酚用量的影响。方法择期全麻下行妇科腹腔镜探查术的患者40例,随机分成Dex组(D组)和对照组(C组),每组20例。D组以0.5μg·kg-1Dex稀释成10 mL静脉泵注10 min,再维持0.4μg·kg-1·h-1持续泵注;C组以0.9%氯化钠溶液用相同方法输注。给药后15 min丙泊酚靶控输注(TCI),使丙泊酚靶控效应室浓度(Ce)以1.0μg·mL-1递增,直至Ce为4.0μg·mL-1,手术中以丙泊酚和瑞芬太尼维持。记录用药前(t0)、用药后5 min(t1)、10 min(t2)、15 min(t3)时的NTI、改良清醒镇静评分(MOAA/S),记录诱导时Ce值分别为1.0,2.0,3.0,4.0μg·mL-1下的NTI,记录手术开始时、手术开始后15,30,45 min,缝皮时的Ce值及丙泊酚总用量,记录术毕患者睁眼时间,拔管时间和麻醉后监测治疗室(PACU)停留时间。结果①D组NTI在t0～t3时为(98.5±0.6),(94.0±4.5),(87.5±5.0),(86.8±7.1),C组NTI在对应时点为(98.8±0.8),(98.4±0.7),(98.5±0.6),(98.6±0.4);与C组相比,D组NTI在t1～t3时显著降低(P<0.01)。②诱导过程Ce值为1.0,2.0,3.0,4.0μg.mL-1时,D组NTI分别为(76.4±3.4),(64.5±7.2),(46.8±7.6),(34.3±6.7),C组为(83.7±5.4),(69.4±8.1),(52.2±7.5),(38.0±6.6);不同Ce值时,D组NTI均显著低于C组(P<0.05)。③D组手术中丙泊酚用量(9.1±1.2)mg·kg-1.h-1,显著少于C组的(11.1±1.5)mg·kg-1·h-1(P<0.05)。④术毕两组睁眼时间、拔管时间、PACU停留时间差异无统计学意义(P>0.05)。结论 Dex可明显降低NTI,能增强丙泊酚的麻醉作用,减少手术中丙泊酚用量,对麻醉苏醒无明显影响。Objective To investigate the effects of dexmedetomidine（Dex） on Narcotrend index（NTI） and propofol requirement of patients undergoing gynecological laparoscopic operation.Methods Forty ASA I/II gynecological patients undergoing laparoscopic operation were randomly assigned into two groups：dexmedetomidine treated group（group D,n=20） and the control group（group C,n=20）.Dex（0.5 μg·kg-1） was diluted into 10 mL for pump intravenous infusion 10 min in group D,followed by 0.4 μg·kg-1·h-1 for maintenance.Saline was applied in the same way in group C.Propofol was used by target-controlled infusion（TCI） 15 min after administration,with the target controlled effect-site concentration（Ce） increased gradually at 1.0 μg·mL-1 until the final Ce up to 4.0 μg·mL-1.Propofol and remifentanil were used for the anesthesia maintenance during operation.The vital signs,Ce value,MOAA/S,NTI and propofol requirement were recorded.Results ① The NTI in group D was（98.5±0.6）,（94.0±4.5）,（87.5±5.0）,（86.8±7.1） at t1～t3,that in group C was（98.8±0.8）,（98.4±0.7）,（98.5±0.6）,（98.6±0.4）,respectively.Compared with group C,the NTI in group D was significantly decreased（P〈0.01）.②As Ce was set at 1.0,2.0,3.0,4.0（μg·mL-1）during induction,the NTI in group D was（76.4±3.4）,（64.5±7.2）,（46.8±7.6）,（34.3±6.7）,which in group C was（83.7±5.4）,（69.4±8.1）,（52.2±7.5）,（38.0±6.6）,respectively;and which in group D was significantly lower than that in group C at different Ce values（P〈0.05）.③Propofol requirement in group D was（9.1±1.2） mg·kg-1·h-1,which was significantly lower than that in group C（11.1±1.5） mg·kg-1·h-1（P〈0.05）.Conclusion Dexmedetomidine remarkably decreases NTI,enhances the anesthetic effect of propofol and reduces the requirement of propofol without overtly influencing anesthesia recovery.

关 键 词：右美托咪啶 NARCOTREND指数 丙泊酚 麻醉 全身 

分 类 号：R971.2[医药卫生—药品] R713[医药卫生—药学]