摘要
目的探讨不同剂量右美托咪啶（dexmedetomidine，DEX）用于腹腔镜妇科手术的有效性和安全性。方法美国麻醉医师协会（ASA）分级I～Ⅱ级全麻下择期行腹腔镜妇科手术80例，按照随机数字表法分为4组，每组20例：A组（10ml生理盐水），B组（0．25μg]kgDEX）、C组（0．5μg／kgOEX）、D组（1．0μg／kgDEX），麻醉诱导前4组分别用微量泵恒速输注10min生理盐水、不同剂量DEX（用生理盐水稀释至10m1），记录入室15min后（T0）、输注DEX后（T1）、气管插管前（T2）、插管后（L）、气腹后（T4）、切皮后（B）、术毕（T6）和拔管（B）各时间点动脉压[收缩压（SBP）、舒张压（DBP）]、心率（HR）、脑电双频谱指数（BIS）值，记录苏醒时间、拔管时间、丙泊酚和瑞芬太尼的用药总量以及围手术期副作用。结果A组、B组各时间点的SBP、DBP、HR较诱导前显著升高，而C组、D组无明显变化，插管后血压、HR低于同时点的A组和B组，与诱导前比较差异无统计学意义，D组T1与T0时比较，HR显著降低（P如．05），SBP、DBP升高（P〈0．05）；4组丙泊酚用量分别为（834±109）、（725±94）、（615±110）、（563土97）mg，瑞芬太尼用量分别为（562±53）、（497±32）、（431±41）、（442±37）μg；4组患者的苏醒时间、拔管时间组间比较差异无统计学意义（P〉0．05）；围术期麻黄素和阿托品的使用次数，D组比A组、B组、C组增多（P〈0．05）；苏醒期寒战、躁动及呛咳发生率，C组、D组比A组、B组减少（P〈0．05）。结论0．25μg／kg、0．5μg／kg和1．0μg，kg3种剂量的DEX可以对腹腔镜妇科手术的患者产生良好的镇静作用，减少丙泊酚和瑞芬太尼用量，减少麻醉苏醒期副作用的发生。DEX0．5μg／kg麻醉诱导前单次静脉输注更为平稳。
Objective To investigate the efficacy and safety of different doses of dexmedetomidine （DEX） administered in the laparoscopic gynecological surgery. Methods Eighty patients ASA grades I or I1 , scheduled for elective laparoscopic gynecological surgery under general anesthesia were randomly divided into four groups, 20 patients in each group： group A（Control group, 10 ml normal saline）, group B（0.25 μg/kg DEX）, group C（0.5 μg/kg DEX）, group D（1.0 μg/kg DEX）. Before induction of anesthesia, patients were administered intravenously 10 ml saline or different doses of DEX （diluted with saline to 10 ml） in 10 min with syringe pump respectively. Systolic blood pressure（SBP）, diastolic blood pressure（DBP）, heart rate（HR） and bispectral index （BIS） value were recorded 15 min after entering operating room（T0）, after given dexmedetomidine infusion（%）, immediately before and after tracheal intubation（T2-T3）, after pneumoperitoneu（T4）, after skin incision（T5）, at the end of surgery（T6） and extubation （TT）, meanwhile the amount of propofol and remifentanil, recovery time, extubation time and adverse reactions were also recorded. Results In group A, B, SBP, DBP and HR at each time after intubation was significantly higher than that before induction, while in group C, D there were no significant changes in those parameters among the different time points. SBP, DBP and HR after intubation in group C and group D were lower than that at the same time point in group A and group B. At time point T1, HR were significantly decreased and SBP, DBP increased compared with that at time point To. Values of BIS were significantly lower at time point T1 in group B, C and D （P〈0.05） compared with that at time point To. Values of BIS at time point T1 in group B, C were significantly higher （P〈0.05） compared with that in group D. There were significant differences in the doses of propofol administered in four groups（P〈0.05）, the doses were（834±109）, （725±94）, （615±110）, （563±97） mg in group A, group B, group C and group D respectively. The doses of remifentanil used in four groups were respectively（562±53）, （497±32）, （431±41）, （442±37） μg. Recovery time and extubation time of the patients among 4 group were no statistically significant different （P〉0.05）. The dosage ofepherine and atropine administered in group D increased obviously （P〉0.05） and higher incidence of chill, dysphoria and cough was observed in group A and group B （P〉0.05）. Conclusions Before induction of anesthesia, administration of different doses of DEX have significant sedative effects on patients, can reduce the dose of propofol and remifentanil and may ireduee the adverse reactions. Cardiovascular parameter changes was more stable within different stage of surgery in the group which 0.5 μg/kg DEX was administered before anesthesia.
出处
《国际麻醉学与复苏杂志》
CAS
2012年第8期520-523,529,共5页
International Journal of Anesthesiology and Resuscitation
关键词
右美托咪啶
腹腔镜妇科手术
血流动力学
镇静
副作用
Dexmedetomidine
Laparoscopic gynecological surgery
Hemodynamics
Sedation
Adverse reactions
