腹部手术中右旋美托咪定对全凭静脉麻醉的影响  

Effect of Dexmedetomidine on Total Intravenous Anesthesia in Patients Undergoing Abdominal Surgery

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

机构地区：[1]中山大学附属第一医院麻醉科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2012年第5期649-654,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省科技计划项目(2010B031600045)

摘　　要：【目的】在腹部手术中,以丙泊酚、瑞芬太尼TCI为基础的全凭静脉麻醉,全程复合使用右旋美托咪定,探讨其对丙泊酚用量、术后拔管时间、睁眼时间和复苏期血流动力学变化等指标的影响。【方法】入选患者随机分成实验组1(DEX1)、实验组2(DEX2)、对照组(Control)3组。DEX1组患者于15 min内输注0.5μg/kg右旋美托咪定,随即以0.25μg.kg-1.h-1输注右旋美托咪定至拔管;DEX2患者于15 min内输注0.5μg/kg右旋美托咪定,随即以0.5μg.kg-1.h-1输注右旋美托咪定至拔管;Control组同法输注生理盐水。右旋美托咪定负荷剂量完成后开始丙泊酚TCI输注麻醉诱导,静脉给予顺式阿曲库胺、瑞芬太尼TCI全凭静脉麻醉维持。记录丙泊酚麻醉诱导及围术期各观察点的丙泊酚效应室浓度(Ce)值,术中丙泊酚用量,复苏期拔管时间、睁眼时间、血流动力学数据等。【结果】在麻醉诱导中Narcotrend值达到D2时,DEX 1组和DEX 2组丙泊酚用量明显少于Control组(P<0.05)。全程丙泊酚用量3组间比较有显著性差异(P<0.05)。围手术期各观察点丙泊酚效应室浓度DEX 1和DEX 2组均明显小于Control组(P<0.05)。麻醉复苏期停止输注丙泊酚到拔出气管导管时间3组间比较无统计学差异(P>0.05)。停止瑞芬太尼输注到拔出气管导管时间3组间比较无统计学差异(P>0.05)。睁眼时间DEX 1、DEX 2组均较control明显延长(P<0.05)。麻醉复苏期血压、心率变化实验组较对照组稳定,DEX 2组尤为明显。【结论】成人腹部手术全凭静脉麻醉全程复合较大剂量(0.5μg.kg-1.h-1)右旋美托咪定可减少麻醉诱导和术中各观察点丙泊酚的需要量,术中可节省丙泊酚约25%;右旋美托咪定对麻醉复苏期气管拔管时间无明显影响,但剂量相关性延长睁眼时间,复苏期血流动力学指标更平稳。[Objective]This prospective, randomized, double-blind study was designed to assess whether intraoperative infusion of dexmedetomidine can reduce the dosage of propofol, the time of extubation and opening eyes and make hemodynamic more smooth in extubation. Parameters are received in adult patients undergoing major abdominal surgery with total intravenous anesthesia. [Methods] Nighty patients were randomly assigned to three groups. Group T1 （n = 30） received a loading dose of dexmedetomidine 0.5 mg kg-1 iv during 15 minutes, followed by a continuous infusion at a rate of 0.5 μg-kg-1h-1 throughout the operation. Group T2 （n = 30） received a loading dose of dexmedetomidine 0.5 mg kg-1 iv during 15 minutes, followed by a continuous infusion at a rate of 0.25 μg kg-1 h-1 throughout the operation. Group C （n = 30） received a volume-matched bolus and infusion of placebo （0.9% saline）. The Ce values of propofol in induction, the intraoperative total amount of propofol, the recovery time from stopping propofo! or remifentanil to extubation, the time from stopping remifentanil to open eyes, and the hemodynamic in extubation were recorded. [ Results ] The induction doses of propofol in group T1 [effect site concentrations：（ 1.5 ± 0.8）pLg/mL] and group T2 [ effect site concentrations： （1.6 ± 0.5 ）μg/mL ] were significantly lower than that in group C [ effect site concentrations： （2.2 ± 0.9） μg/mL,P〈 0.05]. In addition, the effect site concentrations of propofol at every intraoperative observation points in group Tl and T2 weresignificantly lower than those in group C （P 〈 0.05）. The total dose of propofol was significantly different （P 〈 0.05）, （ 1399.7 ± 410.5） mg in group C, （1312.1 ± 627.3） mg in group T1 and （1048.0 ± 461.0）mg in group T2. The time from stopping infused propofol （TSP） [group C： （26.5 ± $.8）min; group Tl： （36.0 ±12.8）min; groupT2：（33.0±7.6）min）] and from stopping remifentanil （TSR） to extubation [ group C

关 键 词：右旋美托咪定 全凭静脉麻醉 丙泊酚 效应室浓度 腹部手术 

分 类 号：R614.24[医药卫生—麻醉学]