右美托咪定用于肝脏部分切除术患者麻醉的临床效果  

Clinical effect of dexmedetomidine anesthesia for patients undergoing partial hepatectomy

作　　者：韩明杰[1] 张凌宇[1] Han Mingjie;Zhang Lingyu(Department of Anesthesiology,First Hospital,Ximen University,Xiamen 361001,China)

机构地区：[1]厦门大学附属第一医院麻醉科,厦门361001

出　　处：《国际医药卫生导报》2021年第3期405-410,共6页International Medicine and Health Guidance News

摘　　要：目的观察右美托咪定用于肝脏部分切除术患者全身麻醉的临床效果。方法选取2019年1月至6月于本院择期行肝脏部分切除术的患者60例,将其随机分为右美托咪定组(D组)与对照组(C组),各30例。麻醉诱导:芬太尼4.0μg/kg,丙泊酚2.00~4.00mg/kg,苯磺酸顺式阿曲库铵0.20mg/kg。麻醉维持:D组,右美托咪定负荷量0.5μg/kg(浓度4.0μg/ml)30min内泵注,持续0.2μg·kg^(-1)·h^(-1)泵注;C组给予等容量的0.9%氯化钠盐水泵注;两组丙泊酚2.00~4.00mg·kg^(-1)·h^(-1)泵注,瑞芬太尼5.0~10.0μg·kg^(-1)·h^(-1)泵注,七氟烷MAC0.5~1.0持续吸入,苯磺酸顺式阿曲库铵0.60mg·kg^(-1)·h^(-1)静脉泵注。观察麻醉诱导前(T0)、手术切皮前(T1)、手术开始后10 min(T2)、手术结束时(T3)、患者清醒时(T4)、拔管时(T5)、拔管后5 min(T6)与10 min(T7)时患者MAP与HR;T4~T7及拔管后20min(T8)、30min(T9)、40min(T10)时躁动评分、疼痛评分及寒战评分。结果D组T1~T4时HR明显低于T0[(55.0±7.2)次/min、(62.5±10.2)次/min、(65.5±11.6)次/min、(66.8±10.9)次/min比(76.6±14.3)次/min,均P<0.05];T1时MAP小于T0[(64.2±11.4)mmHg(1 mmHg=0.133 kPa)比(73.8±14.5)mmHg,P<0.05]。C组T1时HR小于T0时[(66±12.1)次/min比(75.7±14.2)次/min,P<0.05],T5、T6时HR大于T0时[(87.7±15.8)次/min、(84.1±14.0)次/min比(75.7±14.2)次/min,均P<0.05]];T1时MAP小于T0时[(63.8±10.6)mmHg比(72.9±14.1)mmHg,P<0.05],T4~T6时MAP大于T0时[(81.5±14.8)mmHg、(85.5±15.8)mmHg、(80.1±15.0)mmHg比(72.9±14.1)mmHg,均P<0.05];C组T1~T6时HR大于D组[(66.1±12.1)次/min比(55.0±7.2)次/min,(78.0±14.6)次/min比(62.5±10.2)次/min,(71.7±10.6)次/min比(65.5±11.6)次/min,(75.5±12.3)次/min比(66.8±10.9)次/min,(87.7±15.8)次/min比(72.6±13.5)次/min,(84.1±14.0)次/min比(70.6±11.1)次/min,均P<0.05],C组T4~T6时MAP大于D组[(81.5±14.8)mmHg比(70.6±12.2)mmHg,(85.5±15.8)mmHg比(75.5±15.1)mmHg,(80.1±15.0)mmHg比(73.1±13.0)mmHg,均P<0.05];T4~T8各观察时刻D组躁动发生率明显低于Objective To observe clinical effect of dexmedetomidine anesthesia for patients undergoing partial hepatectomy.Methods Sixty ASA I or II patients undergoing partial hepatectomy at our hospital from January to June,2019 were randomized into group D and group C,with 30 cases in each group.General anesthesia was induced for all the patients with fentanil 4μg/kg,propofol 2.0~4.00 mg/kg,cis-atracurium 0.20 mg/kg;both groups were pumped propofol 2.00~4.00 mg·kg^(-1)·h^(-1) and remifentanil 5~10μg·kg^(-1)·h^(-1),inhaled sevoflurane 0.5~1.0 MAC,and were intravenously pumped cis-atracurium 0.60 mg·kg^(-1)·h^(-1).In group D,0.5μg/kg dexmedetomidin with a concentration of 4.0μg/ml was infused 30 min before skin incision and continued at 0.2μg kg-1 h-1.In the group C,the patients received an equal amount of normal saline.The heart rates(HR)and mean arterial pressures(MAP)were recorded before anesthesia induction(T0),at skin incision(T1),10 min after skin incision(T2),at the end of the surgery(T3),when the patients came to(T4),at extubation(T5),and 5(T6)and 10 mim(T7)after extubation.The visual analogue scale(VAS)scores,shivering scores,and Sedation-Agitation Scale(SAS)scores were also noted at from T4 to T7 and 20(T8),30(T9),and 40 min(T10)after extubation.Results In group D,the HR was lower at from T1 to T4 than at T0[(55.0±7.2)beats/min,(62.5±10.2)beats/min,(65.5±11.6)beats/min,and(66.8±10.9)beats/min vs.(76.6±14.3)beats/min;all P<0.05];the MAP was significantly lower at T1 than at T0[(64.2±11.4)mmHg(1 mmHg=0.133 kPa)vs.(73.8±14.5)mmHg;P<0.05].In group C,the HR was lower at T1 than at T0[(66±12.1)beats/min vs.(75.7±14.2)beats/min;P<0.05];the HR was higher at T5 and T6 than at T0[(87.7±15.8)beats/min and(84.1±14.0)beats/min vs.(75.7±14.2)beats/min;both P<0.05];the MAP was lower at T1 than at T0[(63.8±10.6)mmHg vs.(72.9±14.1)mmHg;P<0.05];the MAP was higher at T4,T5,and T6 than at T0[(81.5±14.8)mmHg,(85.5±15.8)mmHg,and(80.1±15.0)mmHg vs.(72.9±14.1)mmHg;all P<0.05].The HR's at from T1 to T6 were si

关 键 词：右美托咪定 肝脏部分切除 血流动力学 寒战 躁动 疼痛 

分 类 号：R614[医药卫生—麻醉学]