不同剂量右美托咪定对靶控输注丙泊酚镇静效应的影响  

Influence of different dose dexmedetomidine on sedation effect of target controlled infusion with propofol for patients undergoing epidural anesthesia

作　　者：闫动[1] 王世端[1] 江岩[1] 黄辉[1] 孙健[1] 

机构地区：[1]青岛大学医学院附属医院麻醉科,山东青岛266003

出　　处：《中国新药与临床杂志》2013年第7期544-548,共5页Chinese Journal of New Drugs and Clinical Remedies

摘　　要：目的探讨不同剂量右美托咪定对靶控输注(TCI)丙泊酚辅助镇静效应的影响。方法选择妇科手术患者80例,随机分为对照组(C组)和右美托咪定三组(D1、D2、D3组)。硬膜外麻醉成功后,D1、D2、D3组分别泵注负荷量右美托咪定0.2、0.4、0.6μg.kg-1,泵注时间为10 min,继之按0.2、0.4、0.6μg.kg-1.h-1持续泵注;C组以相同的方法泵注负荷量和持续量的氯化钠注射液。在负荷量之后,四组均同时启动TCI丙泊酚,初始靶浓度为0.5μg.mL-1,根据Ramsay评分(RSS)和BIS值的变化调节丙泊酚靶浓度。观察患者入室时以及BIS分别达85、75、65时的生命体征、RSS及丙泊酚效应室浓度(ce),并记录RSS达5分时的BIS值和丙泊酚ce;记录停止泵注丙泊酚至BIS恢复至≥92时的时间及此时的丙泊酚ce。结果 D1、D2、D3组BIS值为85和75时,RSS低于C组(P<0.05),D2、D3组BIS值为65时RSS低于C组和D1组(P<0.05)。D1、D2、D3组在各时点的丙泊酚ce均显著低于C组(P<0.05),且D2组低于D1,D3组低于D2组(P<0.05)。C、D1、D2、D3组在RSS评分为5分时的BIS值分别为76±7、71±6、65±5、58±4,其中D2、D3组BIS值明显低于C组(P<0.05)。C组和D1组分别发生呼吸抑制7和6例,均高于D2组和D3组(均为1例,P<0.05);D3组发生心动过缓6例,高于其他三组(P<0.05)。结论复合一定剂量的右美托咪定在降低丙泊酚ce的同时可以改善辅助硬膜外麻醉的术中镇静效果,增加丙泊酚辅助镇静安全性。右美托咪定0.4μg.kg-1负荷量后续以0.4μg.kg-1.h-1维持的效果较好。AIM To investigate the influence of different dose dexmedetomidine （Dex） on sedation effect of target controlled infusion （TCI） with propofol for patients undergoing epidural anesthesia. METHODS Eighty female patients scheduled for elective gynecological operation under epidural anesthesia were randomly divided into 4 groups （n = 20 each group） ： control group （group C）, low-dose Dex group （group D1） , middle-dose Dex group （group D2）, and high-dose Dex group （group D3）. After epidural anesthesia, group D1, D2, D3 received Dex 0.2, 0.4, 0.6μg·kg^-1 initial loading dose respectively by micro-pump for 10 min and maintaining with 0.2, 0.4, 0.6 μg·kg^-1·h^-1 respectively; group C received the equal volume of sodium chloride injection. After the loading dose, all groups received TCI of propofol with target concentration at 0.5 μg·mL^-1. The target concentration of propofol was adjusted according to the ramsay score （RSS） and bispectral index （BIS）. RESULTS RSS of group D1, D2, D3 were significantly lower than those of group C （P 〈 0.05） when the BIS to 85 and 75. RSS of group DE, D3 were significantly lower than those of group C and D1 （P 〈 0.05） when the BIS to 65. The effect chamber concentration （ce） of propofol of group D1, D2, D3 were significantly lower than those of group C （P 〈 0.05）, and group D3 lower than D,, DE; group D= lower than group D1 （P 〈 0.05） at each point. The BIS of 4 groups were 76 ± 7, 71 ± 6, 65 ± 5, 58 ± 4 respectively when the RSS reached to 5. The BIS of group D2 and D3 were significantly lower than those of group C. Seven patients in the group C and 6 patients in the group D1 occurred respiratory depression respectively. The incidence of respiratory depression in the group C and group D1 was significantly higher than that in the group DE and D3 （only one patient occurred respiratory depression, P 〈 0.05）. Six patients occurred bradycardia in the group D3, and the incidence in the group D3 was significantly

关 键 词：右美托咪定 丙泊酚 清醒镇静 麻醉 硬膜外 靶控输注 

分 类 号：R971[医药卫生—药品]