不同剂量右美托咪定复合丙泊酚-瑞芬太尼对肝功能异常患者腹部手术的麻醉效果与安全性评价  

Effect and safety evaluation of different doses of Dexmedetomidine combined with Propofol and Remifentanil on abnormal liver function patients with abdominal surgery anesthesia

作　　者：国松[1] 姜万维[1] 郭旭东[1] 

机构地区：[1]大连大学附属中山医院麻醉科,辽宁大连116001

出　　处：《中国医药导报》2015年第34期98-101,121,共5页China Medical Herald

摘　　要：目的研究不同剂量右美托咪定复合丙泊酚-瑞芬太尼对肝功能异常患者腹部手术的麻醉效果与安全性。方法选取2013年1月~2015年1月于大连大学附属中山医院行胃肠腹部手术的肝功能异常患者80例分为A组和B组,每组各40例,选择同期行胃肠腹部手术的无肝功能异常患者40例为对照组。对照组与A组使用低剂量右美托咪定及丙泊酚复合瑞芬太尼,B组使用高剂量右美托咪定及丙泊酚复合瑞芬太尼。分别于静脉输注右美托咪定前（T_0）、气管插管前（T_1）、气管插管后（T_2）、开腹即刻（T_3）、术中40 min（T_4）采集患者动脉血,HPLC法检测患者血浆去甲肾上腺素（NE）和肾上腺素（E）浓度。记录T_1~T_4、术中60 min（T_5）和术中90 min（T_6）血浆丙泊酚靶浓度变化情况。记录并比较两组患者出现的不良反应。结果对照组和A组麻醉总有效率高于B组,差异有统计学意义（P〈0.05）,对照组和A组差异无统计学意义（P〉0.05）。对照组和A组麻醉苏醒时间及治疗总时间显著低于B组,差异有统计学意义（P〈0.05）。三组患者T_1~T_4时NE及E浓度均降低,T_3、T_4时B组患者NE和E的浓度显著低于A组和对照组,差异具有统计学意义（P〈0.05）。T_1~T_6时间内A组血浆丙泊酚靶浓度均高于B组,差异有统计学意义（P〈0.05）,同组患者T_1~T_6血浆丙泊酚靶浓度差异无统计学意义（P〉0.05）。B组患者术中心动过缓发生率明显高于A组,差异有统计学意义（P〈0.05）,三组苏醒期恶心呕吐发生率相同。结论小剂量右美托咪定可能有效提高麻醉效果,减少患者苏醒时间及术后不良反应,减轻血流动力学波动,提高患者麻醉苏醒质量,值得临床推广应用。Objective To investigate the effect and the safety of different doses of Dexmedetomidine combined with Propofol and Remifentanil on abnormal liver function patients with abdominal surgery anesthesia.Methods January 2013 to January 2015,in Zhongshan Hospital Affiliated to Dalian University,80 patients with abnormal liver function underwent gastrointestinal abdominal surgery were selected and divided into group A and group B,at the same period,40 with normal liver function undergoing gastrointestinal abdominal surgery were selected as cotrol group.The control group and group A were given low dose of Dexmedetomidine and Propofol combined with Remifentanil,group B was given high dose of Dexmedetomidine Propofol combined with Remifentanil.Arterial blood of patients was collected at different time including before Dexmedetomidine intravenous infusion（T_0）,before endotracheal intubation（T_1）,after endotracheal intubation（T_2）,while laparotomy（T_3）,during surgery 40 min（T_4）,the concentration of Epinephrine（E） and norepinephrine（NE） were detected by HPLC method.The plasma Propofol concentration was recorded at T_1-T_4 and during surgery 40（T_5）,90 min（T_6）.The adverse reactions of patients were recorded and compared.Results The anesthesia total effective rate in group A and control group were higher than that in group B,the differences were statistically significant（P〈0.05）,those of group A and control group were compared,the difference was not statistically significant（P〉0.05）.The recovery time and the total time of anesthesia in group A and control group were significantly lower than those in group B,the differences were statistically significant（P〈0.05）.The concentrations of NE and E in three groups reduced at T_1-T_4,the concentrations of NE and E in group B at T_3,T_4 were lower than those in group A and control group,the differences were statistically significant（P〈0.05）.At T_1-T_6,the plasma Propofol concentration in group A were higher than those in grou

关 键 词：右美托咪定 丙泊酚 瑞芬太尼 肝功能异常 

分 类 号：R614[医药卫生—麻醉学]