单次预注右美托咪定对患者全身麻醉诱导时临床效果的影响  

Influence of once pre-injection dexmedetomidine on clinical effects in general anesthesia induction

作　　者：胡光俊 王庆利 陶军[1] 宋晓阳[1] 

机构地区：[1]中国人民解放军武汉总医院麻醉科,武汉430070

出　　处：《重庆医学》2018年第5期644-646,共3页Chongqing medicine

摘　　要：目的观察单次预注右美托咪定(DEX)对行全身麻醉(以下简称全麻)患者诱导时临床效果的影响。方法选择ASAⅠ~Ⅲ级(性别不限),择期在全麻下行腹腔镜胆囊切除术患者60例,将其分为输注1μg/kg DEX组(D组)和生理盐水对照组(C组),每组30例。输完后记录患者脑电双频指数(BIS)值,按照血浆浓度靶控输注(Marsh模式)丙泊酚,逐渐增加血浆浓度直到BIS值达到40,记录此时丙泊酚的效应室浓度(Ce),给予舒芬太尼0.5μg/kg(10s内注射完),记录给予舒芬太尼后1min内呛咳的发生率,再给予顺阿曲库铵。四个成串刺激(TOF)为0时行气管插管,记录TOF值到0的时间(起效时间)和插管时间。记录患者给药前(T0),给药后(T1)、诱导后(T2)、插管后(T3)的血流动力学指标及患者术中知晓发生率。结果注射舒芬太尼后1min内呛咳发生率D组明显低于C组(3.33%vs.13.33%,P<0.01);D组丙泊酚的Ce低于C组(P<0.01)。D组患者中T1、T2点心率(HR)下降;C组患者中T2点HR、平均动脉压(MAP)下降,T3点HR、MAP上升。所有患者均未发生术中知晓。结论诱导前预注射1μg/kg的DEX能够降低患者丙泊酚的用量,维持血流动力学稳定。Objective To observe the influence of once pre-injection dexmedetomidine（DEX） on clinical effect in general an- esthesia induction. Methods Sixty patients, ASA I -Ⅲ , no sex limitation, undergoing elective laparoscopic cholecystectomy under general anesthesia were selected and divided into the lug/kg DEX group（D） and normal saline control group（C）, 30 cases in each group. The BIS values were recorded after medication infusion. Then the target controlled infusion（Marsh mode） of propofol was per/ormed according to the plasma concentration. The plasma concentration was gradually increased until BIS value reaching 40. Then the effect-site concentration（Ce） of propofol was recorded at this time and sufentanil 0.5ug/kg was injected within 10 s. The bucking incidence rate within 1 min after injection of sufentanil was recorded and cisatracurium was injected again. The tracheal in- tubation was performed when the TOF value was 0. The time of train-of-four stimulation（TOF） to 0（ effect onset time） and intuba- tion time were recorded. The hemodynamic indexes were recorded at pre-administration（T0）, post-administration（T1）, after induc- tion（T2） ,and after intubation（T3）. The incidence rate of intraoperative awareness was recorded. Results The bucking incidence rate at 1 rain after sufentanil injection in the group D was significantly lower than that in fhe group C（3.33% vs. 13.3% ,P〈 0.01）. Ce of propofol in the group D was lower than that in the group C（P〈0.01）. HR at T1 in the group D was decreased;HR and MAP at T2 in the group C were decreased,which at T3 were increased. No intraoperative awareness occurred in all cases. Con- clusion Predniection of DEX lua/kg before induction can decrease the DroDofol dose and maintains hemodvnamic stability.

关 键 词：右美托咪定 舒芬太尼 血流动力学 麻醉 全身 诱导 

分 类 号：R614[医药卫生—麻醉学]