复合异丙酚麻醉诱导时右美托咪定的适宜剂量  

Optimum dose of dexmedetomidine when combined with propofol for induction of anesthesia

作　　者：沈卫华[1] 陈樱[1] 李云胜[2] 陈倩茹[1] 凌洪锋[1] 刘克玄[2] 

机构地区：[1]中山大学中山眼科中心麻醉科,广州市510080 [2]中山大学附属第一医院麻醉科

出　　处：《中华麻醉学杂志》2014年第4期398-401,共4页Chinese Journal of Anesthesiology

摘　　要：目的 探讨复合异丙酚麻醉诱导时右美托咪定的适宜剂量.方法 择期行全身麻醉下眼科手术患者120例,年龄18～60岁,体重指数BMI 18.5 ～ 30.0 kg/m2,性别不限,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其分为6组（n=20）：生理盐水组（NS组）、不同剂量右美托咪定组（D1组-D5组）.D1组-D5组分别静脉输注负荷量右美托咪定（以生理盐水稀释至50 ml）0.2 μg/kg（D1组）、0.4μg/kg（D2组）、0.6 μg/kg（D3组）、0.8 μg/kg（D4组）和1.0 μg/kg（D5组）,NS组以等容量生理盐水替代,15min内输注完毕.观察10 min后,采用序贯法TCI异丙酚,以患者意识消失为阳性反应,起始血浆靶浓度为3.2 μg/ml.计算TCI异丙酚使患者意识消失的半数有效浓度（EC50）及其95％可信区间（Cl）.于右美托咪定给药后,TCI异丙酚前记录不良反应的发生情况.结果 与NS组比较,D2组-D5组TCI异丙酚使患者意识消失的EC50降低（P＜0.05）,D1组TCI异丙酚使患者意识消失的EC50差异无统计学意义（P＞0.05）.D1组与D2组、D2组与D3组、D4组与D5组间TCI异丙酚使患者意识消失的EC50随剂量增加逐渐降低（P ＜0.05或0.01）,D3组与D4组间TCI异丙酚使患者意识消失的EC50差异无统计学意义（P＞0.05）.D3组、D4组、D5组低血压的发生率分别为5％、11％、31％,心动过缓的发生率分别为0、11％、19％,D1组和D2组未见低血压和心动过缓的发生.与NS组、D1组、D2组和D3组比较,D4组与D5组低血压和心动过缓的发生率升高（P＜0.01）.结论 复合异丙酚麻醉诱导时右美托咪定的适宜剂量为0.4 μg/kg.Objective To investigate the optimum dose of dexmedetomidine when combined with propofol for induction of anesthesia.Methods One hundred and twenty ASA physical status Ⅰ or 1Ⅱ patients of beth sexes,aged 18-60 yr,with body mass index of 18.5-30.0 kg/m2,scheduled for elective ophthalmologic operation under general anesthesia,were randomly divided into 6 groups （n =20 each） using a random number table：normal saline group （NS group） and different doses of dexmedetomidine groups （D1-D5 groups）.Different loading doses of dexmedetomidine 0.2,0.4,0.6,0.8 and 1.0 μg/kg （in normal saline 50 ml） were infused intravenously in D1-D5 groups,respectively.The equal volume of normal saline was infused over 15 min in group NS.After 10 min observation,target-controlled infusion （TCI） of propofol was started.The initial target plasma concentration was set at 3.2 μg/ml.Loss of consciousness was considered to be positive response.The median effective concentration （EC50） and 95% confidence interval of propofol TCI required for loss of consciousness were calculated.After administration of dexmedetomidine,the development of adverse effects was recorded before propofol TCI.Results Compared with NS group,the EC50 of propofol TCI required for loss of consciousness was significantly decreased in D2-D5 groups,and no significant change was found in the EC50 of propofol TCI required for loss of consciousness in D1 group.The EC50 of propofol TCI was decreased gradually with the increasing doses of dexmedetomidine between D1 and D2 groups,between D2 and D3 groups,and between D4 and D5 groups,while there was no significant difference in the EC50 of propofol TCI required for loss of consciousness between D3 and D4 groups.The incidence of hypotension was 5% （D3 group）,11% （D4 group） and 31% （D5 group）,and the incidence of bradycardia was 0 （D3 group）,11% （D4 group）,and 19 % （D5 group）.No hypotension and bradycardia developed in D1 and D2 groups.The incidence of hypotension and bradycardia was

关 键 词：右美托咪啶 剂量效应关系 药物 二异丙酚 

分 类 号：R614[医药卫生—麻醉学]