右美托咪定用于高龄患者腹腔镜胆囊切除术全麻维持的临床研究  

Clinical study of dexmedetomidine in elderly patients undergoing laparoscopic cholecystectomy under general anesthesia

作　　者：颜景佳[1] 王阵英 刘西将 赵桀[1] 江长城[1] 

机构地区：[1]福建医科大学附属泉州第一医院麻醉科,362000 [2]福建省泉州市永春县医院麻醉科

出　　处：《临床麻醉学杂志》2014年第6期543-545,共3页Journal of Clinical Anesthesiology

基　　金：福建省泉州市科技局科研基金(2011Z61)

摘　　要：目的探讨右美托咪定代替丙泊酚镇静用于高龄患者腹腔镜胆囊切除术（LC）中麻醉维持的可行性。方法选择择期行LC的70岁以上高龄患者90例，随机分为丙泊酚＋瑞芬太尼麻醉维持组（A组）和右美托咪定＋瑞芬太尼麻醉维持组（B组），每组45例。A组患者诱导前不给药，B组患者给予0．5μg／kg负荷剂量的右美托咪定静脉注射，在10min内静注完毕。两组患者麻醉诱导方法相同，诱导后均经口插入3#或4#喉罩。麻醉维持：A组以丙泊酚2．0～3．0μg／ml＋瑞芬太尼4．5～5．5ng／ml静脉TCI维持麻醉；B组在麻醉诱导后则以右美托咪定0．25μg·kg^-1·h^-＋瑞芬太尼4．5～5．5ng／ml静脉TCI。观察插入喉罩时（T1）、手术开始进镜时（T2）、游离胆囊时（T3）、撤镜时（T4）、拔除喉罩时（T5）的HR、SBP、DBP、BIS值。观察两组患者术后的苏醒时间和拔除喉罩时的Steward苏醒评分和改良OAA／S评级。结果不同时点两组BIS比较差异无统计学意义。与A组比较，T1～T5时B组HR明显减慢，SBP、DBP明显降低（P〈0．05）。术毕两组的苏醒时间和拔除喉罩时Steward苏醒评分、改良OAA／S评级差异均无统计学意义。结论右美托咪定代替丙泊酚镇静用于高龄患者腹腔镜胆囊切除术术中的麻醉维持安全有效，且血流动力学的波动更小。Objective Replacement of dexmedetomidine with propofol for maintaining the anesthesia in elderly patients undergoing laparoscopic eholecystectomy. Methods Ninety patients, over 70 years old, undergoing laparoseopic cholecystectomy were randomly divided into 2 groups, propofol combined with remifentanil （group A）, dexmedetomidine combined with remifentanil （group B）, 45 patients in each group. Group A was not treated with any preoperative medication, while group B was treated with loading dose of 0.5 μg/kg dexmedetomidine intravenously completed within 10 minutes. Induction methods were same in both groups, 3# or 4# laryngeal mask were inserted after induction in both groups. Maintenance of anesthesia in group A treated with propofol 2. 0-3.0 μg/ml ＋ 4.5-5.5 ng/ml TCI; Maintenance of anesthesia in group B treated with dexmedetomidine 0.25μg·kg^-1 ·h ^-1 ＋ remifentanil 4.5-5.5 ng/ml （TCI）. HR, SBP,DBP,BIS were recorded at inserting the LMA （T1）, beginning of the surgery （T2）, dissociate the cholecyst （T3）, withdrawal of the laparoscope （T4）, extubate the LMA （T5）. Postoperative recovery time, Steward awakening score and modified OAA/S score at extubation time were recorded. Results No significant difference was found between BIS value of two groups at different time point. Compared with group A, HR at T1-T5 in group Bwere significantly lower, SBP, DBP were significantly decreased （P〈0.05）. There was no significant difference between Steward awakening score and modified OAA/S score at recovery and extubation time in two groups. Conclusion Dexmedetomidine replacing propofol can be safely used in laparoscopic cholecysteetomy with less hemodynamic changes during maintenance of anesthesia in elderly patients.

关 键 词：右美托咪定 高龄 腹腔镜手术麻醉 脑电双频指数 

分 类 号：R614[医药卫生—麻醉学]