不同剂量右美托咪定复合异丙酚用于鼾症患者药物诱导睡眠内镜检查的效果  

Efficacy of different doses of dexmedetomidine combined with propofol for drug-induced sleep endoscopy in patients with snoring

作　　者：贾瑞芳[1] 许辉杰[2] 杨明[1] 左明章[1] 

机构地区：[1]北京医院麻醉科,100730 [2]北京医院耳鼻喉科

出　　处：《中华麻醉学杂志》2016年第3期314-317,共4页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金（61271410）

摘　　要：目的 评价不同剂量右美托咪定复合异丙酚用于鼾症患者药物诱导睡眠内镜检查的效果.方法 拟行药物诱导睡眠内镜检查的鼾症患者60例,性别不限,年龄24～ 62岁,BMI 24～37 kg/m2,ASA分级Ⅰ或Ⅱ级,采用随机数字表法将患者分为2组（n=30）,Ⅰ组和Ⅱ组分别经10 min静脉输注右美托咪定负荷剂量0.4和0.8 μg/kg后,随后均以0.4 μg·kg-1 ·h-1的速率静脉输注,开始输注15 min时TCI异丙酚,初始血浆靶浓度（Cp）为1.0μg/ml,待效应室浓度和血浆浓度平衡2 min时以0.2 μg/ml的梯度调整异丙酚Cp,检查时维持异丙酚Cp不变.分别于麻醉前（T1）、输注右美托咪定10 min（T2）、15 min（T3）、异丙酚效应室浓度和血浆浓度在1.0 μg/ml平衡2 min时（T4）、检查开始时（T5）、鼻咽喉镜到达口咽部（T6）、检查结束（T7）、苏醒（T8）、出检查室（T9）时记录BIS值;分别于T14时记录RASS镇静评分.记录输注右美托咪定15 min内入睡情况;记录苏醒时间、出室时间和麻醉药物有关不良事件的发生情况.结果 所有患者均成功完成检查;输注右美托咪定期间BIS值均维持于75～ 90,RASS镇静评分≤4分;检查期间BIS值维持于65 ～ 75;与Ⅰ组比较,Ⅱ组T4时BIS值降低,T2、4时RASS镇静评分升高,输注右美托咪定15 min内入睡率升高,检查时异丙酚Cp降低,苏醒时间延长（P＜0.05）,出室时间和麻醉药物有关不良事件发生率差异无统计学意义（P＞0.05）.结论 静脉输注右美托咪定负荷剂量0.8 μg/kg后以0.4 μg·kg-1·h-1的速率输注复合异丙酚用于鼾症患者药物诱导睡眠内镜检查的效果较好.Objective To evaluate the efficacy of different doses of dexmedetomidine combined with propofol for drug-induced sleep endoscopy （DISE） in the patients with snoring.Methods Sixty patients with snoring,aged 24-62 yr,with body mass index of 24-37 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective DISE,were randomly divided into either group Ⅰ or group Ⅱ,with 30 patients in each group.In Ⅰ and Ⅱ groups,dexmedetomidine was infused over 10 min in a loading dose of 0.4 and 0.8 μg/kg,respectively,followed by an infusion of 0.4 μg · kg-1 · h-1.At 15 min of dexmedetomidine infusion,propofol was given by target-controlled infusion with the initial target plasma concentration （Cp） of 1.0 μg/ml.At 2 min after the target effect-site and plasma concentrations were balanced,the Cp of propofol was increased/decreased by 0.2 μg/ml to maintain the Cp of propofol stable during DISE.Bispectral index （BIS） value was recorded before anesthesia （T1）,at 10 and 15 min of dexmedetomidine infusion （T2,3）,at 2 min after the target effect-site and plasma concentrations were balanced （T4）,at the beginning of DISE （T5）,when the fiberoptic laryngoscope was placed at the site of oropharynx （T6）,at the end of DISE （T7）,at emergence （T8）,and while discharge from the examination room （T9）.Richmond Agitation Sedation Scale （RASS） scores were recorded at T1-4.Sleep was recorded within 15 min of dexmedetomidine infusion.The emergence time,discharge time,and anesthetics-related adverse events were recorded.Results All the patients completed DISE successfully.BIS values were maintained at 75-90,and RASS scores ≤ 4 during dexmedetomidine infusion.BIS values were maintained at 65-75 during DISE.Compared with group Ⅰ,BIS values were significantly decreased at T4,and RASS scores were significantly increased at T2-4,the sleep rate was significantly increased within 15 min of dexmedetomidine infusion,the Cp of propofol was significantly decreased du

关 键 词：右美托咪啶 二异丙酚 打鼾 内窥镜检查 睡眠 

分 类 号：R614[医药卫生—麻醉学]