摘要
目的:探讨右旋美托咪定(Dex)对全麻患者麻醉药用量、对气管插管和拔管引起的应激反应的抑制作用以及对麻醉恢复期的影响。方法:选择60例择期手术全麻患者(ASAⅠ～Ⅱ级),将患者随机分成Dex组和对照组,每组各30例。Dex组将右旋美托咪定稀释成4μg/kg并以负荷量1.0μg/kg在全麻诱导前15分钟缓慢静脉泵注,对照组静脉泵注等容量生理盐水。全麻诱导时使用丙泊酚2mg/kg、芬太尼2μg/kg、维库溴铵0.15mg/kg静注。4分钟后进行气管内插管。插管成功后吸入七氟醚。Dex组静脉泵注右旋美托咪定0.5μg/(kg·小时)至手术结束,对照组静脉泵注同等容量的生理盐水。手术结束时停用七氟醚,记录患者丙泊酚诱导量(mg/kg)和芬太尼总用量,记录患者入室时(T0)、插管时(T1)、手术后睁眼时(T2)、拔管时(T3)、拔管后10分钟(T4)的HR、平均动脉压(MAP),记录术后呼吸恢复时间、睁眼时间和拔管时间及麻醉恢复期寒颤发生例数。结果:与对照组比较,Dex组的丙泊酚诱导量和芬太尼总用量明显减少(P<0.01)。对照组在T1、T3的MAP、HR与基础值T0比较明显升高(P<0.01),Dex组T1～T4的MAP、HR与基础值T0比较则无明显变化;Dex组在T1、T3的MAP、HR与对照组比较明显降低(P<0.01)。与对照组比较,Dex组术后麻醉恢复期寒颤发生率明显减少(P<0.01)。结论:右旋美托咪啶具有镇静、抗焦虑、镇痛、抗交感、降低应激反应、稳定血液动力学的作用,美托咪啶用于全身麻醉可明显减少麻醉剂用量;减少寒战的发生,降低围术期心肌缺血的发生。
To dexmedetomidine （Dex） on patients undergoing general anesthesia,the dosage of anesthetics on tracheal intubation and extubation induced stress response inhibition as well as on anesthesia recovery period effect. Methods：60 cases of patients with general anesthesia for elective operation （ ASA ｜ - 1] ） ,patients were randomly divided into Dex group and control group, 30 cases in each group. The Dex group of dexmedetomidine is diluted to 4μg/kg and to load 1. 0μg/kg before induction of anesthesia in 15 minutes slow intravenous infusion, the control group intravenous injection of equal volume of physiological saline.Induction of general anesthesia using propofol 2mg/kg, fentanyl 2μg/kg, vecuronium 0. 15mg/kg intravenous. 4minutes after endotracheal intubation. After successful intubation inhalation of sevoflurane. Group Dex intravenous dexmedetomidine 0.5 txg/（ kg · h） and the operation ended, the control group intravenous injection of equal volumes of saline. At the end of operation to deactivate the sevoflurane,propofol induction dose records of patients （rng/kg） and fentanyl total dosage, recorded in the house （ To ） , intubation（ T1 ） after operation, eyes open （ T2 ） , extubation after extubation （ T2） , 10min （ HR,T4 ） mean arterial pressure（MAP） ,recording of postoperative respiratory recovery time,wake time and time to extubation and anesthesia convalescent shivering cases. Resuits ： compared with the control group, Dex group of propofol and fentanyl induced amount total amount decreased significantly （P 〈 O. O1 ）. In the control group; T1,T3 MAP, HR T0 was elevated in comparison with the base value （ P 〈 0.01 ）, group Dex T1 ,T3 MAP, HR compared with the control group decreased significantly （ P 〈 0.01 ）. Compared with the control group,Dex group after anesthesia convalescent shivering incidence decreased significantly （ P 〈 0.01 ）. Conclusion ： Dexmedetomidine sedation, analgesia, with anxiolytic, sympatholytie, reduces the stress response, stable hemodynamic function, dexmedetomidine for general anesthesia can obviously decrease the anes- thetic dosage; reduces the shivering occurfence, reduces perioperative myocardial ischemia occurred.
关键词
右旋美托咪定
丙泊酚
芬太尼
麻醉恢复期
dexmedetomidine
propofol
fentanyl
anesthesia recovery period
