右美托咪啶复合芬太尼及七氟烷用于脑肿瘤手术的麻醉效果及对血流动力学的影响  

Anesthesia Effect of Dexmedetomidine Combined with Fentanyl and Sevoflurane in Brain Tumor Operation and Its Influence on Hemodynamics

作　　者：林赛娟[1,2] 田国刚[1,2] 姚欢琦[1,2] 田毅[1,2] 王颖林[1,2] 董盛龙[1,2] 王召燕 朱少飞[1,2] 

机构地区：[1]海口市人民医院 [2]中南大学湘雅医学院附属海口医院麻醉科,海南海口570208

出　　处：《现代生物医学进展》2015年第18期3540-3543,共4页Progress in Modern Biomedicine

基　　金：海南省自然科学基金项目(2012-SZR-04-07 812170)

摘　　要：目的：探讨右美托咪啶复合芬太尼及七氟烷用于脑肿瘤手术的麻醉效果及对血流动力学的影响。方法：择期全麻下行脑肿瘤切除术患者40例,随机分为右美托咪啶组（D组）和丙泊酚组（P组）各20例。麻醉诱导前D组静脉输注右美托咪啶0.5μg/kg,P组给予同等容量的生理盐水,均15 min泵注完成。静脉注射咪唑安定、芬太尼、顺式阿曲库铵、依托咪酯行麻醉诱导。术中均用芬太尼、七氟烷、顺式阿曲库铵维持麻醉,D组持续静脉输注右美托咪啶0.2-1.0μg·kg^-1·h^-1,P组给予丙泊酚3-10 mg·kg^-1·h^-1,调整右美托咪啶及丙泊酚用量,使BIS值维持于40-50。于麻醉用药前（基础值）（T0）、麻醉诱导气管插管前（T1）、气管插管后（T2）、切开硬脑膜（T3）、取瘤（T4）、术毕（T5）、拔气管导管时（T6）记录心率（HR）、血压（SBP、DBP）。记录手术时间、输液量、出血量、苏醒时间、拔管时间及拔管后10 min警觉/镇静（OAA/S）评分。结果：与T0比较,D组T1、T3、T4时SBP、DBP明显降低（P〈0.05）,HR明显减慢（P〈0.05）,但仍接近正常值,P组T1时SBP、DBP明显降低（P〈0.05）,HR明显减慢（P〈0.05）,T2、T5、T6时SBP、DBP明显升高（P〈0.05）,HR明显加快（P〈0.05）。与P组比较,T2-T6时D组SBP、DBP明显低于P组（P〈0.05）,HR明显慢于P组（P〈0.05）。D组苏醒时间、拔管时间明显短于P组（P〈0.05）,拔管后10min OAA/S评分显著高于P组（P〈0.05）。结论：右美托咪啶或丙泊酚复合芬太尼、七氟烷麻醉用于脑肿瘤手术均能够提供满意的麻醉效果,右美托咪啶能抑制气管插管、拔管等引起的血流动力学反应,术后苏醒快且苏醒质量高。Objective： To investigate the anesthesia effect of dexmedetomidine combined with fentanyl and s oflurane in brain tumor operation and its influence on hemodynamics. Methods： A total of 40 patients, undergoing elective brain tumor resection under general anesthesia, were randomly divided into dexmedetomidine group（D group, n=20） and propofol group（P group, n=20）. Before anaesthesia, D group was treated with intravenous dexmedetomidine（ 0.5 μg/kg） induction, and P group, the equivalent volumes of normal saline for 15 mins. The two grups were treated with intravenous midazolam, fentanyl, CIS atracurium, etomidate for anesthesia induction. Fentanyl, sevoflurane and CIS atracurium were used to maintain the anesthesia of the two groups during the operation; then D group was given with continuous intravenous infusion of dexmedetomidine 0.2-1.0 μg·kg^-1·h^-1; while P group, propofol 3-10 mg·kg^-1·h^-1. After that, the dosage of dexmedetomidine and propofol were adjusted to keep the BIS value in 40-50. HR, SBP, DBP were recorded before anaesthesia（T0）, before tracheal intubation of anesthesia induction（T1）, after tracheal intubation（T2）, dura mater incision（T3）,taking tumor（T4）, operation completing（T5）, and tracheal extubation（T6）; record the operation time, transfusion volume, amount of bleeding,awakening time, extubation time and the OAA/S score 10 min after extubation. Results： Compared with T0, the SBP, DBP were obviously cut down（P〈0.05） and HR was slower of D group at T1, T3, T4（P〈0.05）, but they were still close to the normal value;while the SBP, DBP were obviously cut down（P〈0.05） and HR was slower of P group at T1（P〈0.05）, and SBP, DBP obviously increased（P〈0.05） and HR was faster at T2, T5, T6（P〈0.05）. SBP and DBP of D group were significantly lower than those of P group at T2-T6（P〈0.05）, and the HR was slower than P group（P〈0.05）. The awakening and extubation time of D group were significantly shorter than those

关 键 词：右美托咪啶 丙泊酚 芬太尼 七氟烷 脑肿瘤 

分 类 号：R614[医药卫生—麻醉学] R739.4[医药卫生—外科学]