不同剂量右美托咪定复合舒芬太尼对脊柱侧弯矫形术患者术中唤醒试验的效应  

Effects of Different Doses of Dexmedetomidine-sufentanil on Intraoperative Wake-up Test in Patients Undergoing Scoliosis Surgery

作　　者：唐玲玲 张承华[2] 董发团[2] 

机构地区：[1]云南省第三人民医院麻醉科,云南昆明650011 [2]成都军区昆明总医院麻醉科,云南昆明650032

出　　处：《昆明医科大学学报》2015年第4期118-120,128,共4页Journal of Kunming Medical University

基　　金：云南省应用基础研究基金资助项目(2011FZ317)

摘　　要：目的比较不同剂量右美托咪定复合舒芬太尼对脊柱侧弯矫形术患者术中唤醒试验的效应．方法择期脊柱侧弯矫形术患者90例，年龄13～18岁．采用随机数字表法，将患者随机分为3组（n=30）：生理盐水对照组（C组）；不同剂量右美托咪定组（D1、D2组），分别在麻醉诱导前30min静脉输注右美托咪定负荷量1．0μg／kg，注射时间15min，随后以0．2、0．3μg/（kg·h）的速率静脉输注至术中唤醒试验开始前10min．3组均采用舒芬太尼、依托咪酯、顺阿曲库铵麻醉诱导，气管插管后机械通气．术中靶控吸入七氟醚复合靶控输注舒芬太尼维持麻醉，舒芬太尼效应室靶浓度0．2ng／mL，七氟醚呼气末靶浓度根据BIS值调整．唤醒试验前5min停止输注顺阿曲库铵，下调七氟醚呼气末靶浓度至0、舒芬太尼Ce至0.1ng／mL，直至唤醒试验成功．结果与C组比较，D1、D2组唤醒前七氟醚用量减少，唤醒期间高血压、心动过速、呛咳，躁动的发生率降低，D2组唤醒试验时间延长（P〈0．05）．结论右美托眯定复合舒芬太尼用于脊柱侧弯矫形术患者术中唤醒试验，抑制伤害性刺激诱发心血管反应及呛咳／躁动不良反应，且不影响唤醒时间的术中维持适宜剂量为0,2μg/（kg·h）．Objective To compare the effects of different doses intraoperative wake-up test in patients undergoing scoliosis surgery under of dexmedetomidine-sufentanil on analgesia with sufentanil. Methods Ninety ASA I patients, aged 13-18 yr, scheduled for scoliosis surgery, were randomly divided into 3 groups （n = 30 each） ： control group （group C） and different doses of dexmedetomidine group （groups D1 and D2） Dexmedetomidine was intravenously infused at 0.2 and 0.3 μg/（kg·h） until the end of operation after a loading dose of 1.0 μg/kg over 15 min before induction of anesthesia in groups D1～2, while the equal volume of normal saline was infused in group C. Anesthesia was induced with iv injection of sufentanil and etomidate. Tracheal intubation was facilitated with 0.15 mg/kg cisatracurium besylate and the patients were mechanically ventilated. Anesthesia was maintained with target-controlled infusion sufentanil and target-controlled inhalation sevoflurane. During intraoperative wake-up test, sufentanil was maintained with target-controlled effect-site concentration 0.1 ng/ml in three groups. Results Compared with group C, the consumption of sevoflurane was significantly shorter, the incidence of cardiovascular responses and bucking and/or restlessness of patients during intraoperative wake-up test was significantly shorter in groups D1-2; the intraoperative wake-up test time was significantly shorter in group D1 than in group D2 （P 〈 0.05） Conclusion When the dose of dexmedetomidine 0.2 μg/（kg·h）, it may effectively inhibit the reaction to noxious stimulation and keep the stable of hemodymamics during intraoperative wake-up test in patients undergoing scoliosis surgery.

关 键 词：药物释放系统 右美托咪啶 舒芬太尼 剂量效应关系 唤醒试验 脊柱侧凸 

分 类 号：R614[医药卫生—麻醉学]