不同剂量右美托咪定用于腹腔镜下子宫恶性肿瘤手术中的临床观察  

作　　者：邓爱琴[1] 邓智连[1] 徐倩[1] 徐林[1] 

机构地区：[1]江西省妇幼保健院麻醉科,江西330006

出　　处：《当代医学》2016年第34期5-6,共2页Contemporary Medicine

基　　金：江西省科技厅项目(20132BBG70078)

摘　　要：目的 探讨右美托咪定用于腹腔镜下子宫恶性肿瘤手术中的合适剂量。方法 选择ASAⅠ-Ⅱ级择期行腹腔镜子宫恶性肿瘤切除手术患者80例,随机分为4组,对照组（C）：静脉输注生理盐水50 mL;低、中、高剂量右美托咪定（D1组、D2组、D3组）：分别静脉输注右美托咪定0.25μg/kg、0.50μg/kg和1.00μg/kg（均用生理盐水稀释至50 mL）给予负荷剂量,输注时间为15 min,然后再按0.25μg/（kg·h）、0.5μg/（kg·h）和1.0μg/（kg·h）持续泵入,直至手术结束。分别记录入室安静时（T0）、给完右美托咪定负荷剂量时（T1）、麻醉诱导结束时（T2）、气管插管时（T3）、气腹时（T4）腹腔放气时（T5）、拔管时（T6）拔管后半小时（T7）的血压和心率;苏醒时间;术后嗜睡、躁动、寒战、恶心、呕吐、头痛等并发症。结果 T0时4组的血压和心率比较差异无统计学意义;C、D1组T2时心率、血压明显低于T0时,T3、T4、T6时的心率、血压高于T0（P〈0.05）;T0～T7时D2、D3组的血压和心率比较差异无统计学意义;D3组的苏醒时间较C、D1、D2明显延长,嗜睡率增加,差异有统计学意义（P〈0.05）.结论0.5μg/kg负荷量加0.5μg/（kg·h）的维持量的右美托咪定即能维持血流动力学稳定,减少并发症的发生;又不增加患者的苏醒时间,是用于腹腔镜下子宫恶性肿瘤手术中的合适剂量.Objective To investigate the appropriate doses of dexmedetomidine for laparoscopic uterine cancer surgery.Methods ASA Ⅰ-Ⅱ grade elective laparoscopic uterine cancer surgery 80 patients were randomly divided into four groups, the control group （C）： intravenous injection of normal saline 50mL; low, medium and high doses of dexmedetomidine given （groupD1, D2, D3）： respectively dexmedetomidine infusion set 0.25μg/kg, 0.50μg/kg and 1.00μg/kg （both diluted with saline to 50mL） loading dose, infusion time15 minutes, then press 0.25μg/（kg·h）, 0.5μg/（kg·h） and 1.0μg/（kg·h） continuous infusion until the end of surgery. They were recorded in quiet in the room （T0）, after dexmedetomidine loading dose （T1）, anesthesia induction end （T2）, tracheal intubation （T3）, pneumoperitoneum （T4） intraperitoneal delfated （T5）, extubation （T6）, half an hour after extubation （T7） blood pressure and heart rate; recovery time; postoperative drowsiness, restlessness, chills, nausea, vomiting, headache and other complications.Results At T0 four groups of blood pressure and heart rate had no signiifcant difference; C, D1 group T2 heart rate, blood pressure and heart rate was signiifcantly lower than of T0, T3, T4, T6 the blood pressure is higher than T0 （P〈0.05）; T0-T7 in the D2, D3 group blood pressure, heart rate, did not change signiifcantly; signiifcantly prolongs the recovery time of the D3 group compared with C, D1, D2. lethargy rate increased （P〈0.05）.Conclusion 0.5μg/kg load plus 0.5μg/（kg·h） maintenance dose of dexmedetomidine is able to maintaina hemodynamic stability, reduce complications; without increasing the patient＆#39;s recovery time, is for laparoscopic surgery of uterine cancer in the appropriate dose.

关 键 词：右美托咪定 恶性肿瘤 子宫 腹腔镜 

分 类 号：R614[医药卫生—麻醉学] R737.33[医药卫生—外科学]