右美托咪定对丙泊酚复合瑞芬太尼全身麻醉中血流动力学及麻药用量的影响

摘要

Objective To observe the effects of dexmedetomidine on hemodynamics and anesthetic dosage during gen-eral anesthesia with propofol combined with remifentanil. Methods Sixty patients underwent gynecological laparoscopic surgery in general anesthesia were selected and randomly divided into 3 groups:control group (Group P,normal saline), single infusion of dexmedetomidine group (Group D,intravenous dexmedetomidine 0.5 μg/kg)and continuous infusion of dexemdetomidine group[Group C,intravenous dexmedetomidine 0.5μg/kg and then constant infusion at 0.15μg/(kg·h)]. SBP,DBP and HR were recorded in the following times:before injection(T0),before anesthetic induction(T1),before intuba-tion(T2),instant after intubation(T3),after intubation of 3 min(T4),after pneumoperitoneum(T5),drug withdrawal immediately after surgery(T6),instant after extubation(T7)and after extubationof 3 min(T8).The dosage of propofol and remifentanil were recorded during the surgery. Results SBP at T3,T5 and T7,DBP at T5 and T7,HR at T1-T7 in group C was lower than that in group P respectively,with statistical difference (P<0.05).SBP at T3,T5,HR at T1-T7 in group D was lower than that in group P respectively,with statistical difference (P<0.05). In group P,SBP at T3,T5 and T7,DBP at T7 was higher than that T0 respectively,HR at T2,T4-T6 was lower than that T0 respectively,HR at T7 was higher than that T0, with statistical difference(P<0.05).In group C,HR at T1-T6 was lower than that T0 respectively,with statistical difference (P<0.05).The dosage of remifentanil in group C was less than that in goup P,with statistical difference (P<0.01).The dosage of propofol in three groups was compared,with no statistical difference (P>0.05). Conclusion Con-tinuous infusion of dexemdetomidine with low dose can effectively reduce the hemodynamic fluctuation in endotracheal intubation,pneumoperitoneum and extubation from patients during general anesthesia in laparoscopic operation,as well as decrease the dosage of remifentanil.%目的：观察右美托咪定对丙泊酚复合瑞芬太尼全身麻醉中血流动力学及麻药用量的影响。方法选择全身麻醉下行择期妇科腹腔镜手术患者60例，随机分为3组：对照组(P组)、单次输注右美托咪定组(D组)及持续输注右美托咪定组(C组)，每组20例。全身麻醉诱导前，D组静脉泵注右美托咪定0.5μg/kg；C组按同速静脉泵注右美托咪定0.5μg/kg，之后以0.15μg/(kg·h)速率持续泵注至术毕前30 min；P组给予等容积生理盐水。记录患者在注药前(T0)、麻醉诱导前(T1)、插管前(T2)、插管后即刻(T3)、插管后3 min(T4)、气腹后(T5)、术毕停药即刻(T6)、拔管后即刻(T7)和拔管后3 min(T8)的收缩压、舒张压、心率；术中丙泊酚和瑞芬太尼的用量。结果 C组T3、T5、T7时点SBP，T5、T7时点DBP及T1~T7时点HR低于P组，差异均有统计学意义(P<0.05)；D组T3、T5时点SBP及T1~T7时点HR低于P组，差异均有统计学意义(P<0.05)；P组T3、T5、T7时点SBP，T7时点DBP均高于T0时点，T2和T4~T6时点HR均低于T0时点，T7时点HR高于T0时点，差异均有统计学意义(P<0.05)；D组T2~T6时点HR均低于T0时点，差异均有统计学意义(P<0.05)；C组T1~T6时点HR均低于T0时点，差异均有统计学意义(P<0.05)。C组瑞芬太尼用量较P组减少，差异有统计学意义(P<0.01)；3组丙泊酚用量比较差异无统计学意义(P>0.05)。结论持续低剂量输注右美托咪定可以有效减轻全身麻醉腹腔镜手术患者在气管插管、气腹和术后拔管过程中的血流动力学波动，并能减少瑞芬太尼的用量。