右旋美托咪啶对全麻患者CSI及七氟醚呼气末浓度的影响

摘要

目的 研究右旋美托咪啶对全麻患者CSI及七氟醚呼气末浓度的影响.方法 选择ASAI-Ⅱ级择期在静吸复合全身麻醉下手术患者100例,随机分为两组(n=50),D组:将负荷量0.4 μg/kg右旋美托咪啶用微量泵10 min静脉泵注,然后再将维持量0.4 μg/kg/h泵注;C组:泵注0.9%NaCl溶液.两组麻醉方案相同,记录各时间点的收缩压(SBP)、舒张压(DBP)、平均动脉压(MBP)、心率(HR)、脉搏血氧饱和度(SpO2)、脑功能状态指数(CSI)的变化以及七氟醚的呼气末浓度.结果 术前两组间各个指标无差异.D组血压、CSI在泵注右旋美托咪啶后明显下降(P＜0.05),D组与C组患者在T0及T1时HR、SBP、DBP、CSI没有统计学差异(P＞0.05).而之后T2、T3、T4三个时间点D组患者与T1比SBP、CSI均明显下降,有统计学意义(P＜0.05或P＜0.01).麻醉及手术开始后维持相同麻醉深度(即CSI为37-43之间)时,两组患者的血液动力学指标无明显差异,七氟醚的呼气末浓度有明显差异(P＜0.05).结论 在全麻患者中应用右旋美托咪啶可以降低CSI,起到增加麻醉深度的作用;并且在CSI维持在37-43之间时七氟醚呼气末浓度可降低约26%,减少七氟醚的用量.%Objective Study the effect of dexmedetomidine on general anesthesia in patients with CSI and end-tidal concentrations of scvofluranc. Methods Select 100 patients who arc ASA I-II-class selective inhalation general anesthesia in surgery,randomly divided into two groups,D group (n=50) :loading docs 0. 4μg/kg Dexmedetomidine and pumping it with micro_pump in 10 min,and then pumping the maintenance docs 0. 4 μg/kg/h;C group (n=50) pumping 0. 9% NaCl solution. The same two groups of anesthetized,at each time point recording systolic blood prcssurc(SBP) ,di-astolic blood pressure (DBP),mcan arterial pressure (MBP) , heart rate (HR), pulse oxygen saturation (SpO2 ), cerebral state index (CSI) of the change and end-tidal concentrations of scvofluranc. Results Each index before surgery has no difference between the two groups. Blood pressure and CSI of D group after pumping dexmedetomidine significantly decrease (P<0. 05) .Patients of D group and C group at the time point of TO and T1,HR,SBP,DBP and CSI have no statistical significance(P<0. 05). And then at the time points of T2 ,T3,T4 ,patients in D group significantly decreased than at the time point of Tl in SBP,CSI,and have statistical significance (P<0. 05 or P<0. 01). During anesthesia and surgery, maintaining the same depth of anesthesia (i. c. CSI changing between 37 to 43) ,blood dynamics indexes has no obvious difference between the two groups of patients, however, end-tidal concentrations of scvofluranc have obvious difference (P<0. 05). Conclusion The application of anesthesia in patients with dexmedetomidine reduces CSI,plays a role in increasing the depth of anesthesia; and that can reduce end-tidal concentrations of scvofluranc approximately 26% when CSI changing between 37 to 43,and save the amount of scvofluranc.