不同剂量右美托咪定复合瑞芬太尼和丙泊酚用于非气管插管烧伤患者麻醉效果的比较  

Comparison of different doses of dexmedetomidine combined with remifentanil and propofol for anesthesia in burn patients with non-intubation

作　　者：刘敏肖 刘立永 宋子贤[2] 王勇[2] 刘微[2] Liu Minxiao;Liu Liyong;Song Zixian;Wang Yong;Liu Wei(Department of Anesthesiology, Hebei Youai Hospital, Shijiazhuang 050011, China;Department of Anesthesiology, Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang 050000,China)

机构地区：[1]河北友爱医院麻醉科,石家庄050011 [2]河北医科大学第四医院麻醉科,石家庄050000

出　　处：《中华麻醉学杂志》2019年第4期459-461,共3页Chinese Journal of Anesthesiology

摘　　要：目的比较不同剂量右美托咪定复合瑞芬太尼和丙泊酚用于非气管插管烧伤患者的麻醉效果。方法择期行小于10%面积烧伤植皮术、烧伤磨削痂术或10%~50%烧伤面积换药患者60例,性别不限,年龄18~64岁,体重指数19~24 kg/m2,ASA分级Ⅰ或Ⅱ级。采用随机数字表法分为3组,每组20例。A组、B组和C组均以恒速静脉输注右美托咪定1.0 μg/kg,输注时间10 min,随后分别以0.6、0.8和1.0 μg·kg^-1·h^-1输注至约术毕前10 min。3组均利用双通道静脉TCI瑞芬太尼和丙泊酚,调整丙泊酚血浆靶浓度维持意识指数40~60,术毕时停药。术中观察呼吸抑制、体动反应和低血压的发生情况,记录瑞芬太尼和丙泊酚的用量、苏醒时间,术后1 h时行Ramsay镇静评分。结果与A组比较,B组和C组呼吸抑制发生率和丙泊酚用量降低,镇静满意率升高,C组低血压发生率升高(P<0.05);与B组比较,C组低血压发生率升高(P<0.05)。3组瑞芬太尼用量和苏醒时间比较差异无统计学意义(P>0.05),均未见体动反应发生。结论静脉输注右美托咪定0.8 μg·kg^-1·h^-1复合瑞芬太尼和丙泊酚用于非气管插管烧伤患者的麻醉效果较好。Objective To compare the different doses of dexmedetomidine combined with remifentanil and propofol for anesthesia in the burn patients with non-intubation. Methods Sixty burn patients of both sexes, aged 18-64 yr, with body mass index of 19-24 kg/m2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective skin grafting with burn covering less than 10% of the total body surface, tangential excision, or dressing change with burn covering 10%-50% of the total body surface, were selected and divided into A, B and C groups using a random number table method, with 20 patients in each group. In A, B and C groups, dexmedetomidine 1.0 μg/kg was intravenously infused for 10 min at a constant rate, followed by an infusion of 0.6, 0.8 and 1.0 μg·kg-1·h-1, respectively, until 10 min before the end of surgery.Remifentanil and propofol were given by target-controlled infusion via the dual channel, the target plasma concentration of propofol was adjusted to maintain the index of consciousness at 40-60, and administration was stopped at the end of surgery in three groups. The development of respiratory depression, body movement and hypotension was observed during operation. The consumption of remifentanil and propofol, emergence time and Ramsay sedation score at 1 h after operation were recorded. Results Compared with group A, the incidence of respiratory depression and consumption of propofol were significantly decreased, and the rate of satisfaction with sedation was increased in B and C groups (P<0.05), and the incidence of hypotension was significantly increased in group C (P<0.05). The incidence of hypotension was significantly higher in group C than in group B (P<0.05). There were no significant differences in the consumption of remifentanil or emergence time among three groups (P>0.05), and no body movement was found in three groups. Conclusion Intravenously infused dexmedetomidine 0.8 μg·kg-1·h-1 combined with remifentanil and propofol provides better efficacy when used for the

关 键 词：右美托咪啶 哌啶类 二异丙酚 烧伤 

分 类 号：R614[医药卫生—麻醉学]