右旋美托咪定用于静脉全麻正颌手术的疗效观察  

Effect of dexmedetomidine on total intravenous anesthesia in orthognathic surgery

作　　者：雷蕾[1,2] 康伟[1,2] 刘伟珍[1,2] 夏璇[1,2] 姚林川[1,2] 

机构地区：[1]广东省口腔医院 [2]南方医科大学附属口腔医院麻醉科,广州510280

出　　处：《山西医科大学学报》2014年第3期238-241,共4页Journal of Shanxi Medical University

摘　　要：目的双颌正颌手术中,在以丙泊酚、瑞芬太尼全凭静脉麻醉(target controlled infusion,TCI)为基础的静脉全麻中复合使用右旋美托咪定(dexmedetomidine,Dex),观察其对围术期血流动力学及麻醉并发症的影响。方法入选双颌畸形患者60例随机分为Dex组和对照组,每组30例。Dex组于15 min内泵注0.4μg/kg负荷剂量Dex,随即以0.4μg/(kg·h)泵注至拔管;对照组同法泵注生理盐水。Dex负荷剂量完成后静注丙泊酚1.5 mg/kg、顺式阿曲库胺0.2 mg/kg、瑞芬太尼1.0μg/kg快速诱导经鼻插管。麻醉维持用丙泊酚、瑞芬太尼TCI并恒速泵注顺式阿曲库胺0.1 mg/(kg·h)。监测脑电双频谱指数,使其维持在45-55。记录麻醉前(T0基础值)、插气管导管时(T1)、上颌前庭黏膜切开时(T2)、上颌骨切开时(T3)、下颌骨劈开时(T4)、拔除气管导管时(T5)、拔除气管导管后15 min(T6)7个时点血流动力学数据及拔管后不良反应发生情况。结果与对照组比较,Dex组平均动脉压、心率于T1-T5各时点均明显降低(P<0.01);寒战、躁动、谵妄、呛咳与对照组比均明显减少(P<0.05)。结论正颌手术中,Dex复合静脉全麻是一种值得推荐的麻醉方法。Objective To investigate the hemodynamic changes and complications after total intravenous anesthesia with dexmedetomi- dine（Dex） and propofol and remifentanil target controlled infusion（TCl） in orthognathic surgery for dento-maxillofacial deformities. Methods Sixty patients with maxillary and mandible deformities were randomly assigned to combination group and control group. Pa- tients were infused with 0.4 μg/kg dexmedetomidine within 15 min and then 0.4 μg/（ kg · h） for maintainence until the extubation in combination group and normal saline in control group. The patients were injected intravenously with the sequence of propofol （ 1.5 mg/kg） ,cisatracurium（0.2 mg/kg） and remifentanil（ 1.0 μg/kg） for rapid induction and then nasal cannula. Anesthesia was main- tained with propofol and remifentanil TCI,while constant infusion of cisatracurium 0.1 mg/（ kg · h）. The data of bispectral index were recorded and maintained at 45 -55. The hemodynamics were recorded before anesthesia （T0, baseline）, at the process of inserting en- dotracheal tube （ Tl ）, the time of cutting maxillary vestibular mucosa （ T2 ）, the time of cutting maxilla （ T3 ）, the time of splitting mandi- ble（T4 ）, at the extubation（T5 ）, at 15 rain after extubation（T6 ）. Adverse reaction was recorded after extubation. Results Compared with control group, the mean arterial pressure and the heart rate in combination group at Tl -T5 significantly decreased （P 〈 0.01 ）. The incidence of adverse reactions（ chills ,restlessness ,delirium,cough） in combination group was significantly lower than in control group （P 〈 0.05）. Conclusion Based on propofol and remifentanil TCI, the combination of dexmedetomidine for total intravenous anesthe- sia is a recommended clinical anesthesia in orthognathic surgery.

关 键 词：右旋美托咪定 静脉全麻 正颌手术 麻醉后并发症 

分 类 号：R614[医药卫生—麻醉学]