右美托咪定和瑞芬太尼复合麻醉提高合并高血压腹腔镜手术患者的术后复苏质量  

Study on improving the quality of postoperative recovery in hypertensive patients undergoing laparoscopic surgery with combined anesthesia of dexmedetomidine and remifentanil

作　　者：董楠[1] 张继如[1] 郑雁 凌育峰 何水清 DONG Nan;ZHANG Jiru;ZHENG Yan;LING Yufeng;HE Shuiqing(Department of Anesthesiology,Affiliated Hospital of Jiangnan University,Wuxi,Jiangsu 214125,China)

机构地区：[1]江南大学附属医院麻醉科,江苏无锡214125

出　　处：《重庆医学》2023年第16期2439-2443,共5页Chongqing medicine

基　　金：江苏省社会发展面上项目(BE2020634);江苏省自然科学基金面上项目(BK20191138);无锡市中青年医疗卫生拔尖人才项目(BJ2020049);江南大学附属医院临床研究与转化医学研究项目(LCYJ202226)。

摘　　要：目的探讨右美托咪定复合瑞芬太尼是否有利于合并高血压的腹腔镜手术患者术后复苏。方法选择合并高血压择期腹腔镜手术患者116例,美国麻醉医师协会(ASA)分级Ⅱ~Ⅲ级。分为右美托咪定+丙泊酚+瑞芬太尼组(DPR组)和丙泊酚+瑞芬太尼组(PR组),各58例。两组麻醉诱导方法相同。麻醉维持:DPR组用微量泵输注右美托咪定0.6~1.0μg·kg^(-1)·h^(-1)+丙泊酚4.0~6.0 mg·kg^(-1)·h^(-1),PR组用微量泵输注丙泊酚5.0~10.0 mg·kg^(-1)·h^(-1),两组均泵入瑞芬太尼0.2~0.5 mg·kg^(-1)·h^(-1)+顺苯磺酸阿曲库铵0.15~0.18 mg·kg^(-1)·h^(-1)。观察各时间点的血流动力学参数;记录麻醉时间、手术时间、苏醒时间、拔管时间;采用镇静-觉醒评分评价意识状态。结果两组苏醒时间、拔管时间均较短,DPR组术后苏醒疼痛评分更低(P<0.05);与DPR组比较,PR组在T1和T3两个时间点血压明显升高,差异有统计学意义(P<0.05)。结论对合并高血压的腹腔镜手术患者,右美托咪定复合瑞芬太尼麻醉血流动力学更加平稳,术后复苏镇痛效果更加完善。Objective To determine whether the combination of dexmedetomidine and remifentanil is beneficial for the recovery of hypertensive patients after laparoscopic surgery.Methods A total of 116 patients with hypertension,who were scheduled for elective laparoscopic surgery,were selected.They were classified as American Society of Anesthesiologists(ASA)level Ⅱ to Ⅲ.They were randomly divided into two groups,with 58 cases in each group.Dexmedetomidine+propofol+remifentanil(DPR group)and propofol+remifentanil(PR group)groups.The anesthesia induction method was the same in both groups.Anesthesia maintenance:in the DPR group,dexmedetomidine 0.6-1.0μg·kg^(-1)·h^(-1)+propofol 4.0-6.0 mg·kg^(-1)·h^(-1) were i nfused with a micropump.In the PR group,propofol 5.0-10.0 mg·kg^(-1)·h^(-1) was infused with a micropump.Both groups were also infused with remifentanil 0.2-0.5 mg·kg^(-1)·h^(-1)+atracurium cis-besylate ammonium 0.15-0.18 mg·kg^(-1)·h^(-1).The revised text separates the different infusions in each group for clarity.The hemodynamic parameters at different time points were observed,anesthesia time,surgery time,recovery time,and extubation time were recorded.Additionally,alert/sedation scoring to evaluate the level of consciousness were used.Results The wake-up time and extubation time of both groups were shorter,and the wake-up time was deemed safe.However,the postoperative wake-up pain score of the DPR group was lower,and this difference was statistically significant(P<0.05).Compared to the DPR group,blood pressure showed a significant increase at two time points,T1 and T3,with a statistically significant difference(P<0.05).Conclusion For patients with hypertension undergoing laparoscopic surgery,the combination of dexmedetomidine and remifentanil anesthesia provides more stable hemodynamics and improved postoperative analgesic effects.

关 键 词：右美托咪定 瑞芬太尼 高血压 腹腔镜手术 麻醉 复苏 

分 类 号：R320.21[医药卫生—人体解剖和组织胚胎学]