右美托咪定对妇科腹腔镜手术术中血液动力学和术后恢复的效应  

Efficacy of dexmedetomidine infusion on hemodynamic response and postoperative recovery in gynecologic laparoscopic surgery

作　　者：郭瑞宏[1] 耿志宇[2] 

机构地区：[1]首都医科大学密云教学医院麻醉科,101500 [2]北京大学第一医院麻醉科

出　　处：《北京医学》2015年第7期667-670,共4页Beijing Medical Journal

摘　　要：目的 探讨右美托咪定复合丙泊酚全麻对妇科腹腔镜手术中血液动力学及术后恢复的影响。方法 选择ASAⅠⅡ级择期全麻下行妇科腹腔镜手术的患者130例,随机分为右美托咪定组（Dex组）和对照组（Con组）,每组各65例。患者均以咪达唑仑0.03 mg/kg、丙泊酚12mg/kg和瑞芬太尼效应室靶控浓度3 ng/ml诱导,术中输注丙泊酚和瑞芬太尼维持麻醉。Dex组在诱导前静脉泵入右美托咪定0.5μg/kg,术中以0.10.2μg/（kg·h）持续输注。Con组静脉泵入等量生理盐水。2组术后均采用吗啡静脉自控镇痛（PCA）。记录患者麻醉诱导、气管插管和拔管期及恢复室（PACU）的血压（MAP）和心率（HR）;术毕停药后的苏醒时间、拔管时间和定向力恢复时间,在PACU及术后24 h的PCA吗啡用量及恶心呕吐、寒战等不良反应发生率。结果 2组患者术后苏醒时间、拔管时间和定向力恢复时间差异均无统计学意义。Dex组丙泊酚诱导量[（1.1±0.2）mg/kg]和术中维持量[（4.1±0.7）mg/kg],小于Con组[（1.6±0.5）和（4.8±1.2）mg/kg],P〈0.01;术后24 h吗啡的PCA按压次数小于Con组（P〈0.05）。Dex组插管后MAP的增加幅度小于Con组（9.5%vs.23.7%）,Dex组气管插管前后的HR均低于Con组。在拔管后和PACU期间,Dex组MAP和HR均低于Con组（P〈0.05）。Dex组患者术中使用阿托品比率较高（P〈0.05）,PACU寒战发生率较低（P〈0.05）。结论 右美托咪定用于全麻妇科腹腔镜手术时,围术期血液动力学平稳,可减少术中丙泊酚和术后吗啡用量,减少术后寒战发生率,不影响术后患者苏醒。Objective To evaluate the effects of dexmedetomidine combined with propofol for general anesthesia on haemodynamic response and postoperative recovery in patients undergoing gynecological laparoscopy. Methods 130 patients scheduled for gynecological laparoscopy were randomly divided into two groups. The dexmedetomidine group （Group Dex, n=65） received dexemedetomidine 0.5μg/kg before induction of anaesthesia followed by 0.1-0.2 μg/（kg, h） during maintenance, while the control group （Group Con, n=65） received volume-matched normal saline infusion as pla- cebo. Propofol and remifentanil were used for induction and maintenance of anesthesia. Haemodynamic parameters and recovery characteristics were evaluated. Patient controlled analgesia was provided for postoperative pain relief. Results There were no significant differences between groups with respect to verbal response time, extubation time, or orientation recovery time. Propofol dosages of induction and maintenance of anesthesia were lower with dexmedetomidine. The post- operative 24 h morphine dosage of PCA demand was significantly less in the Dex group. After tracheal intubation, maxi- mal average increase in mean blood pressure values was 9.5% in Dex group, as compared to 23.7% in the Con group. The heart rates were significantly lower in the Dex group during intubation. The mean blood pressure values and heart rates were lower in the Dex group after extubation and in the PACU. The need for intraoperative atropine was higher in the Dex group. There was less incidence of postoperative shivering in the Dex group. Conclusion Intraoperative use of dexme- detomidine provides stable hemodynamics, spares propofol and postoperative morphine requirements, reduces shivering without delayed recovery during gynecologic laparoscopy surgery.

关 键 词：右美托咪定 麻醉 全身 恢复 术后 血液动力学 

分 类 号：R614[医药卫生—麻醉学]