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右美托咪啶对麻醉维持期及苏醒期影响的临床研究
Dexmedetomidine on maintenance phase of anesthesia and recovery

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DOI:
作者:
王泓波
WANG Hong-bo,CHOU Wei-ping
作者单位:
辽宁省肿瘤医院
Liaoning Tumor Hospital
关键词:
右美托咪啶；七氟醚MAC；苏醒期
Dexmedetomidine; MAC; Emergence
摘要:
【摘要】 目的：观察持续泵注右美托咪啶对全麻病人麻醉维持期七氟烷最低肺泡有效浓度（MAC）及苏醒期安静合作状态的影响。方法：选择全麻下直肠癌根治术病人60名，年龄32-55岁，ASA I -Ⅱ级，随机分为两组：对照组(C组)和右美托咪啶组(D组)。D组病人插管后静脉泵注右美托咪啶负荷量0.3 ug／kg，输注5分钟后，持续输注维持量0.6ug／kg／h，直至手术结束。C组注射等容量生理盐水。记录麻醉维持过程中七氟烷的MAC值和芬太尼用量，记录麻醉维持期间SBP、DBP、HR、BIS值，记录心动过缓和低血压的发生率，以及麻醉时间、手术时间、清醒拔管时间、滞留苏醒室（PACU）的时间。记录拔管时SBP、DBP、HR，拔管时躁动指数，拔管后Ramsay评分及苏醒后镇痛药用量。结果：与C组比较，D组麻醉维持期间七氟烷MAC值下降( P<0.01)，芬太尼用量减少 ( P<0.05)， BIS值降低( P<0.01)， D组在麻醉维持期间T2-T5时间点SBP、DBP、HR与对照组比较有统计学意义。D组阿托品用量多于对照组（P<0.01)，麻黄碱用量两组间比较差异无统计学意义( P>0.05)。两组间麻醉时间、手术时间、拔管时间、清醒时间、离开PACU时间差异无统计学意义( P>0.05)。两组病人在PACU的血液动力学指标、镇痛药用量、拔管时的躁动指数和安静合作状态之间的差异有统计学意义。结论：静脉注射右美托咪啶降低麻醉中七氟烷的MAC值，降低BIS值，循环状态稳定，苏醒期安静合作，无苏醒延迟。
【Abstract】Objective Observation of continuous infusion of the Dexmedetomidineon in patients under general anesthesia on sevoflurane of minimum alveolar concentration (MAC) and the emergence of the state of quiet cooperation. Methods All elective resection of rectal cancer under general anesthesia, 60 patients, aged 32-55 years, ASA class I-Ⅱ, were randomly divided into two groups: control group (C group) and Dexmedetomidine group (D group).D group of patients after intubation intravenous infusion of the Dexmedetomidine loading 0.3 ug / kg, 5 minutes after infusion to maintain the amount of 0.6ug/kg/h, until the end of surgery. C group injected with saline. Records of sevoflurane MAC and fentanyl values during maintenance of anesthesia ,records of SBP, DBP, HR, BIS and anesthesia time, operative time, awake extubation time, time of PACU stay. Record extubation SBP, DBP, HR, extubation agitation index, Ramsay score after extubation, and recovery period of analgesics. Results D Group to reduce the amount of fentanyl during maintenance of anesthesia, sevoflurane MAC value and BIS lower than the control group. D group during maintenance of anesthesia to maintain blood pressure slightly lower level, SBP, DBP ,HR compared with the control group was statistically significant. Dosage of atropine in D group compared with the control group significantly (P<0.01), ephedrine usage between the two groups was no significant difference (P>0.05). Anesthesia time, surgery time, extubation time, recovery time, leaving in PACU time no significant difference. Two groups of analgesics in the PACU, cycle status during extubation , agitation index and the state of quiet cooperation was statistically significant.Conclusion Intravenous injection of the Dexmedetomidine reduced MAC of sevoflurane and BIS,cycle stability, cooperation quiet , no delayed recovery in recovery period.

 

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