不同剂量右美托咪定对小儿七氟烷MAC_(BAR)的影响  

Effects of different doses of dexmedetomidine on MAC_(BAR) of sevoflurane in children

作　　者：周倩[1] 邬艳[2] 黄婵燕[2] 邓绮雯 丘煜鑫[2] 李偲[3] 

机构地区：[1]中山大学公共卫生学院医学统计与流行病学系,广州510080 [2]中山大学附属第一医院麻醉科,广州510080 [3]南方医科大学附属南方医院麻醉科,广州510515

出　　处：《中华普通外科学文献（电子版）》2016年第6期393-396,共4页Chinese Archives of General Surgery(Electronic Edition)

基　　金：国家自然科学基金资助项目(81401630)

摘　　要：目的探讨不同剂量的右美托咪定(Dex)对七氟烷抑制50%患儿切皮诱发肾上腺素能反应的最低肺泡有效浓度(MAC_(BAR))的影响。方法择期拟行下腹部手术患儿81例,年龄2~6岁,ASAⅠ或Ⅱ级,随机分为3组,D_0组(负荷量、维持量均为0.9%氯化钠液)27例,D_(0.5)组(负荷量0.5μg/kg、维持量0.5μg·kg^(-1)·h^(-1))27例,D1组(负荷量1μg/kg、维持量1μg·kg^(-1)·h^(-1))27例。在麻醉诱导前15 min开始输注Dex,气管插管后各组初始的七氟烷呼气末浓度均为4%,按改良序贯法进行试验,以切皮后5 min内MAP或HR升高幅度≥切皮前15%为阳性反应,计算七氟烷MAC_(BAR)及其95%置信区间。结果 3组间比较差异有统计学意义(P<0.01)。D_(0-1)组MAC_(BAR)分别为(3.95±0.1)%(95%CI=3.88%~4.02%)、(3.05±0.1)%(95%CI=2.98%~3.12%)、(1.90±0.0)%(95%CI=1.90%~1.90%)。D_(0.5)组、D_1组的七氟烷MAC_(BAR)较D_0组分别降低了23%、52%,差异有统计学意义(P<0.01)。结论负荷量0.5μg/kg、维持量0.5μg·kg^(-1)·h^(-1)的Dex可降低行下腹部手术小儿七氟烷MAC_(BAR)23%,当Dex剂量增加一倍时,可降低MAC_(BAR)约52%。Objective To observe the effect of different doses of dexmedetomidine（Dex）on the minimum alveolar concentration of sevoflurane to blockade adrenergic response to surgical incision in 50%of children（MAC（BAR））.Methods Eighty-one children,2-6 years old,with ASAⅠorⅡundergoing lower abdominal surgery,were randomly allocated into three groups,receiving saline only（27 cases）or a bolus dose of 0.5 μg/kg and maintenance dose of 0.5 μg·kg^-1·h^-1Dex（27 cases）or a bolus dose of 1 μg/kg and maintenance dose of 1 μg·kg^-1·h^-1Dex（27 cases）before induction.The initial concentration of sevoflurane was 4% for each group after intubation.The ＂modified up-and-down＂ method（Sympathetic responses to surgical incision was considered positive if the MAP or HR increased≥15%）was used,and the MAC（BAR）of sevoflurane and its 95% confidence interval were calculated.Results The differences in the three groups were significant（P0.01）.The MAC（BAR）of sevoflurane was respectively（3.95 ± 0.1）%（95% CI=3.88%-4.02%）in group D0,（3.05±0.1）%（95% CI=2.98%-3.12%）in group D（0.5）,and（1.90±0.0）%（95% CI=1.90%^-1.90%）in group D1.The MAC（BAR）reduction of sevoflurane was 23% in group D（0.5）and 52% in group D1（P0.01）.Conclusions A bolus dose of 0.5 μg/kg and maintenance dose of 0.5 μg·kg^-1·h^-1dexmedetomidine results in a 23% decrease in the MAC（BAR）of sevoflurane.Increasing the dose of dexmedetomidine to 1 μg/kg and 1 μg·kg^-1·h^-1produces a further 29% decrease in the MAC（BAR）values of sevoflurane.

关 键 词：儿科学 七氟烷 右美托咪定 最低肺泡有效浓度 

分 类 号：R726.1[医药卫生—儿科]