摘要
目的观察静脉滴注右美托咪定（dexmedetomidine，Dex）对骨科全麻手术血流动力学及苏醒期的影响，探索合适的Dex静脉滴注的剂量和方法。方法美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级择期全麻骨科手术患者100例，采用随机数字表法将患者分为4组（每组25例）：D1组、D2组、D3组和C组，D1、D2组和D3组患者全麻诱导前10min静脉滴注负荷量Dex0．6μg／kg，再分别静脉滴注Dex0．2、0．4μg·kg^-1·h^-1和0．8μg·kg^-1·h^-1，C组全程静脉滴注等量生理盐水，手术结束前30min停止静脉滴注Dex。以脑电双频指数（bispectral index，BIS）作为麻醉镇静深度指标，术中根据BIS值调节丙泊酚用量以维持麻醉。记录用药前、插管前1min、插管后1min、切皮、拔管前1min及拔管后1min各时间点血流动力学参数及丙泊酚用量，术后患者睁眼时间、拔管时间、定向力恢复时间及术后在麻醉后监测治疗室（postanesthesia care unit，PACU）期间副作用发生情况。结果与C组比较，D1组、D2组和D3组患者的心率（heart rate，HR）在插管后1rain和拔管后1min均明显降低（P〈0．01），收缩压（svstolic blood pressure，SBP）和舒张压（diastolic blood pressure，DBP）在插管后1min、切皮时和拔管后1min均明显降低（P〈0．05）。在相同镇静条件下，C组、D1组、D2组和D3组丙泊酚用量分别为1180、1095、822、696mg，Dex以剂量依赖方式降低术中丙泊酚用量（P〈0．05）。4组患者睁眼时间、拔管时间和定向力恢复时间比较，差异均无统计学意义（P〉0．05）。与C组比较，D1组、D2组和D3组患者术后在PACU期间躁动、恶心呕吐及呼吸抑制发生率明显降低（P〈0．05），但D3组患者嗜睡发生率较高（P〈0．05）。结论术中持续静脉滴注0．2μg·kg^-1·h^-1～O．4μg·kg^-1·h^-1 Dex可维持骨科全麻患者血流动力学稳定，预防气管插管、切皮和拔管引起的心血管反应，减少术中丙泊酚用量，降低术后副作用。
Objective To investigate the effect of continuous intravenous infusion of different doses of dexmedetomidine （Dex） on the intraoperative hemodynamics and recovery period for orthopedic surgery under general anesthesia, to explore appropriate close and method of intravenous infusion of Dex. Methods One hundred ASA Ⅰ～Ⅱ patients （weight 50 kg-75 kg） undergoing elective orthopedic surgery were randomly divided into four groups： group D1, group D2, group D3 and group C. The patients in group D1, group D2 and group D3 were all treated with a continuous intravenous drip of 0.6 μg/kg Dex 10 rain before the induction of general anesthesia, and followed by a continuous intravenous drip of 0.2、0.4μg·kg^-1·h^-1 or 0.8μg·kg^-1·h^-1 Dex, respectively. The patients in group C were treated with the same amount of normal saline. The admistration of Dex was stopped 30 min before the end of surgery. Patients in the four groups were treated with same method of anesthesia. The amount of propofol was adjustted based on bispectral index （BIS）, which was the indicator of the depth of sedation, to maintain anesthesia. The changes of hemodynamic parameters at the time premedication, 1 rain before and after tracheal intubation, insion, 1 rain before and after tracheal extubation, the consumption of propofol, postoperative recovery time to eyes opening, extubation and orientation, and the incidence of agitation, nausea and vomiting, respiratory depression and somnolence were recorded. Results The heart rate （HR） of the time 1 rain after tracheal intubation and extubation was lower than that in group C （P〈0.01） . The systolic blood pressure（SBP） and diastolic blood pressure（DBP） at the time I rain after tracheal intubation, insion and 1 rain after extubation were all lower than that in group C（P〈0.05）. Under the same sedation conditions, consumption of propofol in group C, D1, D2, D3 was 1 180, 1 095, 822, 696 mg, respectively. Dex reduced the consumption of prepofol in a dose-dependent manner （P〈0.05）. The difference of recovery time to eyes opening, extubation and orientation in the four groups was not statistically significant （P〉0.05）. The incidence of postoperative agitation, nausea and vomiting and respiratory depression in group D1, group D2 and group D3 was significantly lower than that in group C （P〈0.05）. But the incidence of somnolence in group D3 was higher compared with group C （P〈0.05）. Conclusions Intraoperative continuous intravenous infusion of 0.2μg·kg^-1·h^-1～O.4μg·kg^-1·h^-1 Dex may effectively maintain stable hemodynamics of patients undergoing orthopedic surgery during general anesthesia, prevent the cardiovascular reactions of tracheal intubation, insion and tracheal extubation, reduce propofol requirement and postoperative adverse reactions, improve the patients outcomes.
出处
《国际麻醉学与复苏杂志》
CAS
2015年第1期23-26,共4页
International Journal of Anesthesiology and Resuscitation
关键词
右美托咪定
丙泊酚
麻醉
全身
骨科手术
Dexmedetomidine
Propofol
Anesthesia, general
Orthopedic surgery
