右美托咪定对丙泊酚闭环靶控输注全凭静脉麻醉的影响  

Effects of dexmedetomidine on general anesthesia with closed-loop target controlled infusion of propofol

作　　者：吕建瑞[1] 张珍妮[1] 王宁[1] 雷晓鸣[1] 李振江[2] 吴刚[1] 李伟[1] 薛荣亮[1] 

机构地区：[1]西安交通大学第二附属医院麻醉科,西安710004 [2]新疆自治区昌吉州人民医院麻醉科

出　　处：《陕西医学杂志》2015年第11期1467-1470,共4页Shaanxi Medical Journal

基　　金：国家临床重点专科建设项目(2011873)

摘　　要：目的：观察右美托咪定（Dex）对丙泊酚闭环靶控输注全凭静脉麻醉的影响。方法：收集全麻下行腹腔镜胆囊切除术患者96例,按数字表法随机分为D1组、D2组、D3和对照组（C组）各24例。四组分别于诱导前泵注Dex0.3、0.6、1.0μg/kg和生理盐水,麻醉诱导维持采用丙泊酚闭环靶控输注。记录输注前（T0）、输注后（T1）、气管插管后即刻（T2）、插管后30min（T3）、术毕（T4）、拔管后（T5）的HR、MAP、BIS值及丙泊酚效应室浓度（Ce）。结果：D2组MAP、HR在各时点均无明显变化,而C组及D1组在T2时MAP升高,D3组在T1时HR减慢。四组患者BIS值在T2-T4时均低于T0,其中,T2、T3时稳定于50左右。D2及D3组丙泊酚Ce在各时点均低于C组。术中D2、D3组丙泊酚用量较C组分别减少36.0%和45.3%;瑞芬太尼用量则减少35.6%和42.5%。四组间苏醒时间及拔管时间比较,差异无统计学意义。苏醒期间,D2和D3组无躁动、呛咳、寒战和术中知晓发生。结论：丙泊酚闭环靶控输注全麻诱导前单次泵注Dex0.6μg/kg,可抑制气管插管时的血流动力学波动,明显减少术中丙泊酚和瑞芬太尼的用量,提高了拔管质量且不影响苏醒时间。Objective：To explore the application of dexmedetomidine on general anesthesia with closedloop target controlled infusion of propofol.Methods：Ninety-six patients undergoing laparoscopic cholecystectomy with general anesthesia were randomly divided into four groups：group D1,D2,D3 and group C.Dexmedetomidine was given with 0.3,0.6and 1.0μg/kg before anesthesia induction in group D1,D2 and D3respectively.The equal volume of normal saline was infused in group C.The MAP,HR,Bispectral index,effect-site concentration（Ce）of propofol were observed at the time before dexmedetomidine infusion（T0）,after dexmedetomidine infusion（T1）,immediately after intubation（T2）,30 min after intubation（T3）,surgery completion（T4）and after extubation（T5）.Results：There was no statistical difference in MAP and HR at each time in group D2.The MAP was higher at T2 than that at T0 in group C and group D1.The HR was lower at T1 than that at T0 in group D3.Bispectral index in four groups were stabilized at 50 at T2and T3.Propofol Ce in group D2 and D3 were decreased than that in Group C at T2-T5.The consumption of propofol in group D2 and D3 were decreased 36.0%and 45.3%than that in Group C,and the consumption of remifentanil were decreased 35.6% and 42.5%.The difference in revival time and extubation time between four groups was not significant.There was no agitation,cough,chills,and intraoperative awareness happened during extubation in group D2 and D3.Conclusion：The application of dexmedetomidine with 0.6μg/kg within 10 min before anesthesia induction with closed-loop target controlled infusion of propofol could inhibit hemodynamic fluctuation during intubation and decrease the consumption of propofol and remifentanil during the surgery.It could improve extubation quality without affecting revival time.

关 键 词：右美托咪定 二异丙酚 闭环靶控输注 麻醉药 静脉 

分 类 号：R614.2[医药卫生—麻醉学]