右美托咪定不同给药方法用于腹腔镜胆囊切除术患者麻醉中的临床观察  

Clinical observation on sedation with different methods of dexmedetomidine administration during general anesthesia in the laparoscopic cholecystectomy

作　　者：郎宇[1] 王天龙[1] 肖娜[2] 

机构地区：[1]首都医科大学宣武医院麻醉科,北京100053 [2]北京潞河医院麻醉科

出　　处：《国际麻醉学与复苏杂志》2013年第9期794-798,共5页International Journal of Anesthesiology and Resuscitation

摘　　要：目的探讨右美托咪定（dexmedetomidine，DEX）不同给药方法在腹腔镜胆囊切除术（1aparoscopiccholecystectomy，LC）患者麻醉中辅助镇静的安全性和可行性。方法100例Lc患者按随机数字表法分为4组：DEX负荷剂量组（Dd组）、持续剂量组（Dc组）、负荷剂量加持续输注剂量组（Ddc组）和对照组（C组），每组25例。通过不同的给药方法观察DEX对围术期循环、呼吸指标、及苏醒和术后镇痛的影响。结果Dd组、Dc组患者在清醒时间及拔管时间较C组、Ddc组明显缩短，清醒时间：（8．4±2．7）、（8．4±4．3）、（11．4±5．5）、（11．2±4．5）min（P〈0．05）；拔管时间：（11．1±3．4）、（10．7±4．1）、（14．1±5．4）、（14．2±6．2）min（P〈0．05）；应用DEX的3组术后2h视觉模拟评分法（visualanaloguescales，VAS）评分明显低于C组（1．2±0．9）、（1．6±0．8）、（1．8±0．7）、（2．5±1．3）（P〈0．05）；Dd组、Dc组和Ddc组在应用DEX后血压和心率（heartrate，HR）明显降低（P〈0．05），与C组比较也明显下降（P〈0．05），但4组患者围术期循环参数均在正常范围内；Dd组、Dc组和Ddc组在麻醉维持中应用的镇痛、镇静药物的总量与C组比较明显减少（P〈0．05）。结论应用负荷剂量、持续剂量及负荷剂量加持续剂量输注的DEX均可用于Lc麻醉中的辅助镇静，既稳定循环又苏醒迅速，负荷剂量及持续剂量输注的方法更优于负荷加持续输注的方法，但仍需大样本研究加以证实。Objective To investigate the feasibility and safety of different methods of dexmedetomidine （DEX） administration on sedation during general anesthesia in the laparoscopic cholecystectomy （LC）. Methods 100 LC patients were randomly divided into four groups： group Dd （loading dose）, group Dc （continuous infusion）, group Ddc （loading dose plus continuous infusing）, and group C （control）. To observe the effects of DEX on circulation indicators, respiratory indicators, awaking and postoperative analgesia through different methods administration of DEX. Results The awake time and extubation time in group Dd and Dc were obviously shorter than group C and Ddc awake time： （8.4± 2.7 ）, （8.4±4.3） versus （11.4±5.5 ）, （11.2±4.5 ） rain （P〈0.05） ; extubation time ： （ 11. 1±3.4）, （ 10.7±4.1 ） versus （ 14.1±5.4） and （14.2±6.2） min（P〈0.05 ）. The visual analogue scales （VAS） in three DEX groups were obviously lower（P〈0.05）than group C （1.2±0.9）, （1.6_＋0.8）, （1.8±0.7） versus （2.5±1.3）（P〈 0.05）. Blood pressure and heart rate （HR）in group Dd, Dc and Ddc decreased significantly after administration of DEX （P〈0.05）. They were also significantly decreased （P〈0.05） compared with group C. However, hemodynamic parameters in 4 groups were all in normal range during operation. The total amout of analgesia and sedative anesthetics were decreased significantly in group Dd, Dc and Ddc when compared with group C during anesthesia maintainance （P〈0.05）. Conclusions Administration DEX with methods of loading dose, continuous infusion and loading plus continuous infusion could all be used as sedation during general anesthesia in LC. The patients wake up quickly, and their circulation is stable. The methods of loading dose and continuous infusion are better than continuous infusion after the loading dose. However, it still need to be confirmed by large-sample study.

关 键 词：腹腔镜胆囊切除术 右美托咪定 镇静 全麻 

分 类 号：R614[医药卫生—麻醉学]