右美托咪定复合七氟醚用于肝叶切除术患者的临床研究  

Clinical trial of dexmedetomidine injection combined with sevoflurane in the treatment of patients with hepatic lobotomy

作　　者：张琴琴[1,2] 孔高茵 潘冰冰[1,2] 黄倩 赵媛[1,2] ZHANG Qin-qin;KONG Gao-yin;PAN Bing-bing;HUANG Qian;ZHAO Yuan(Center of Anesthesiology,People's Hospital of Hunan Province/The First Affiliated Hospital of Hunan Normal University,Changsha 410000,Hunan Province,China;Hunan Provincial Clinical Medical Research Center for Accelerated Rehabilitation and Anesthesia During Perioperative Period,Changsha 410000,Hunan Province,China)

机构地区：[1]湖南省人民医院、湖南师范大学附属第一医院麻醉医学中心,湖南长沙410000 [2]湖南省围术期加速康复麻醉临床医学研究中心,湖南长沙410000

出　　处：《中国临床药理学杂志》2022年第7期635-638,642,共5页The Chinese Journal of Clinical Pharmacology

基　　金：湖南省自然科学基金资助项目(2018JJ3291)。

摘　　要：目的观察右美托咪定复合七氟醚用于肝叶切除术患者的临床疗效及安全性.方法将126例拟进行肝叶切除手术患者随机分为对照组和试验组,每组63例.对照组给予0.04 mg·kg^(-1)咪达唑仑+0.4μg·kg^(-1)舒芬太尼+0.2 mg·kg^(-1)顺苯磺酸阿曲库铵+2 mg·kg^(-1)丙泊酚进行麻醉诱导;给予七氟醚1%~2%+0.1μg·kg^(-1)·min^(-1)瑞芬太尼+1~2μg·kg^(-1)·min^(-1)顺苯磺酸阿曲库铵进行麻醉维持,术前40 min停用;于手术结束前30 min给予10μg·kg^(-1)舒芬太尼.试验组于麻醉诱导前10 min给予1μg·kg^(-1)右美托咪定,注射时间10 min,其余麻醉诱导方法同对照组;给予0.4μg·kg^(-1)·h^(-1)右美托咪定持续泵注进行麻醉维持,其余麻醉维持方法同对照组.比较2组患者的脑氧摄取率(CERO_(2))、髓鞘碱性蛋白(MBP),以及不良事件的发生情况.结果试验组和对照组切皮前(T_(0))CERO_(2)分别为(17.33±2.42)%和(18.03±2.32)%,MBP分别为(18.53±2.74)和(18.12±2.13)μg·L^(-1);肝门开放后60 min(T_(4))CERO_(2)分别为(24.51±3.13)%和(34.32±3.44)%,MBP分别为(24.52±2.51)和(36.53±2.61)μg·L^(-1).2组患者T_(4)时的上述指标均显著高于同组T_(0),且试验组T_(4)时的上述指标均显著低于对照组同期,差异均有统计学意义(均P<0.05).2组患者发生的不良事件均以恶心呕吐、苏醒延迟和术后谵妄为主.试验组和对照组的总不良事件发生率分别为15.87%和19.05%,差异无统计学意义(P>0.05).结论右美托咪定复合七氟醚用于肝叶切除术患者麻醉能够维持血流动力学稳定,降低脑氧代谢,且不增加不良事件的发生率.Objective To observe the clinical efficacy and safety of dexmedetomidine injection combined with sevoflurane in the treatment of patients undergoing hepatectomy.Methods A total of 126 patients undergoing hepatectomy were randomly divided into treatment and control groups with 63 cases per group.The control group was given 0.04 mg·kg^(-1)midazolam+0.4μg·kg^(-1)sufentanil+0.2 mg·kg^(-1)cisatracurium besilate+2 mg·kg^(-1)propofol for anesthesia induction;sevoflurane 1%-2%+0.1μg·kg^(-1)·min^(-1)remifentanil+1-2μg·kg^(-1)·min^(-1)cisatracurium besilate for anesthesia maintenance and stopped 40 min before operation;10μg·kg^(-1)sufentanil was given 30 minutes before the end of operation.10 minutes before anesthesia induction,the treatment group was given 1μg·kg^(-1)dexmedetomidine for 10 minutes and the other anesthesia induction was the same as those in control group;during the operation,0.4μg·kg^(-1)·h^(-1) dexmedetomidine was continuously pumped to maintain anesthesia,and the rest of the anesthesia maintenance methods were the same as those in control group.The cerebral oxygen uptake rate(CERO_(2)),myelin basic protein(MBP)and adverse events were compared between two groups.Results Before skin incision(T_(0)),the levels of CERO_(2)in the treatment and control groups were(17.33±2.42)%and(18.03±2.32)%,the levels of MBP were(18.53±2.74)and(18.12±2.13)μg·L^(-1);60 min after the opening of hepatic hilumthe(T;),the levels of CERO_(2)were(24.51±3.13)%and(34.32±3.44)%,the levels of MBP were(24.52±2.51)and(36.53±2.61)μg·L^(-1).The above-mentioned indexes at T_(4) in the two groups were significantly higher than those in the same group at T;,and the above-mentioned indexes in the treatment group at T_(4) were significantly lower than those in the control group at the same time,so the differences were statistically significant(all P<0.05).The adverse events of two groups were delayed recovery,postoperative delirium,nausea and vomiting.The incidences of adverse events in the treatment and control gr

关 键 词：右美托咪定 七氟醚 肝叶切除术 安全性评价 

分 类 号：R971.2[医药卫生—药品]