复合依托咪酯时右美托咪定用于患者麻醉诱导的适宜剂量  

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

作　　者：郑耀明[1] 刘克玄[2] 于永群[1] 瞿波[1] 陈旭华[1] 容颖雅[1] 胡胜英[1] 方锐伦[1] 

机构地区：[1]广东省江门市人民医院麻醉科,529051 [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12期1455-1457,共3页Chinese Journal of Anesthesiology

摘　　要：目的 探讨复合依托咪酯时右美托咪定用于患者麻醉诱导的适宜剂量.方法 择期全麻手术患者100例,年龄18-60岁,ASA分级Ⅰ或Ⅱ级,BMI 20-25 kg/m^2,采用随机数字表法分为5组（n=20）：对照组（C组）和不同剂量右美托咪定组（D0.2组、D0.4组、D06组和D08组）.经10 min静脉输注50 ml生理盐水（C组）、右美托咪定0.2 μg/kg（D0.2组）、0.4 μg/kg（D0.4组）、0.6 μg/kg（D06组）和0.8μg/kg（D0.8组）后,TCI依托咪酯,初始血浆靶浓度为0.5ug/ml,于TCI开始8 min时进行改良镇静/警觉评分,评分≤3分认为意识消失.采用序贯法进行试验,计算依托咪酯使患者意识消失的半数有效血浆靶浓度（EC50）.记录右美托咪定给药后低血压、心动过缓的发生情况.结果 与C组比较,其余组依托咪酯使患者意识消失的EC50降低（P＜0.05）,D02组、D0.4组、D06组依托咪酯使患者意识消失的EC50逐渐降低（P＜0.05）,D06组与D0.8组依托咪酯使患者意识消失的EC50比较差异无统计学意义（P＞ 005）.C组、D0.2组、D04组和D06组均未见低血压和心动过缓发生,D0.8组低血压发生率为12％,心动过缓发生率为19％.结论 复合依托咪酯时右美托咪定用于患者麻醉诱导的适宜剂量为0.6ug/kg.Objective To investigate the optimum dose of dexmedetomidine for inductionof anesthesia when combined with etomidate.Methods One hundred ASA physical status Ⅰ or Ⅱ patients,aged 18-60 yr,with body mass index of 20-25 kg/m^2,scheduled for elective surgery under general surgery,were randomly divided into 5 groups （n =20 each） using a random number table：control group （group C） and different doses of dexmedetomidine groups （D0.2,D0.4,D0.6 and D0.8 groups）.Norud saline 50 ml and dexmedetomidine 0.2,0.4,0.6 and 0.8 μg/kg were infused intravenously over 10 min in C,D0.2,D0.4,D0.6 and D0.8 groups,respectively.At the end of infusion,etomidate target-controlled infusion was started with the initial target plasma concentration of 0.5 μg/ml.Modified OAA/S score was recorded at 8 min of target-controlled infusion.OAA/S score ≤ 3 was considered as loss of consciousness.Dixon＇ s up-and-down technique was used for test.The median effective concentration （EC50） of etomidate required for inducing loss of consciousness was calculated.The development of hypotension and bradycardia after dexmedetomidine administration was recorded.Results Compared with group C,the EC50 of etomidate required for inducing loss of consciousness was significantly decreased in D0.2,D0.4,D0.6 and D0.8 groups.The EC50 of etomidate required for inducing loss of consciousness was decreased gradually with the increasing doses of dexmedetomidine in D0.2,D0.4 and D0.6 groups.There was no significant difference in the EC50 of etomidate required for inducing loss of consciousness between D0.6 and D0.8 Voups.No hypotension and bradycardia occurred in C,D0.2,D0.4,and D0.6 groups.The incidence of hypotension was 12%,and the incidence of bradycardia was 19% in D0.8 group.Conclusion When combined with etomidate,the optimum dose of dexmedetomidine is 0.6 μtg/kg for induction of anesthesia.

关 键 词：右美托咪啶 依托咪酯 剂量效应关系 药物 

分 类 号：R614[医药卫生—麻醉学]