单次预注右美托咪定对患者全身麻醉诱导时临床效果的影响

摘要

目的 观察单次预注右美托咪定(DEX)对行全身麻醉(以下简称全麻)患者诱导时临床效果的影响.方法 选择ASAⅠ～Ⅲ级(性别不限),择期在全麻下行腹腔镜胆囊切除术患者60例,将其分为输注1μg/kg DEX组(D组)和生理盐水对照组(C组),每组30例.输完后记录患者脑电双频指数(BIS)值,按照血浆浓度靶控输注(Marsh模式)丙泊酚,逐渐增加血浆浓度直到BIS值达到40,记录此时丙泊酚的效应室浓度(Ce),给予舒芬太尼0.5 μg/kg(10 s内注射完),记录给予舒芬太尼后1 min内呛咳的发生率,再给予顺阿曲库铵.四个成串刺激(TOF)为0时行气管插管,记录TOF值到0的时间(起效时间)和插管时间.记录患者给药前(T0),给药后(T1)、诱导后(T2)、插管后(T3)的血流动力学指标及患者术中知晓发生率.结果 注射舒芬太尼后1 min内呛咳发生率D组明显低于C组(3.33％ vs.13.33％,P＜0.01);D组丙泊酚的Ce低于C组(P＜0.01).D组患者中T1、T2点心率(HR)下降;C组患者中T2点HR、平均动脉压(MAP)下降,T3点HR、MAP上升.所有患者均未发生术中知晓.结论 诱导前预注射1 μg/kg的DEX能够降低患者丙泊酚的用量,维持血流动力学稳定.%Objective To observe the influence of once pre-injection dexmedetomidine(DEX) on clinical effect in general anesthesia induction.Methods Sixty patients,ASA Ⅰ-Ⅲ,no sex limitation,undergoing elective laparoscopic cholecystectomy under general anesthesia were selected and divided into the 1ug/kg DEX group(D) and normal saline control group(C),30 cases in each group.The BIS values were recorded after medication infusion.Then the target controlled infusion(Marsh mode) of propofol was performed according to the plasma concentration.The plasma concentration was gradually increased until BIS value reaching 40.Then the effect-site concentration(Ce) of propofol was recorded at this time and sufentanil 0.5ug/kg was injected within 10 s.The bucking incidence rate within 1 min after injection of sufentanil was recorded and cisatracurium was injected again.The tracheal intubation was performed when the TOF value was 0.The time of train-of-four stimulation(TOF) to 0(effect onset time) and intubation time were recorded.The hemodynamic indexes were recorded at pre-administration(T0),post-administration(T1),after induction(T2),and after intubation(T3).The incidence rate of intraoperative awareness was recorded.Results The bucking incidence rate at 1 min after sufentanil injection in the group D was significantly lower than that in the group C(3.33％ vs.13.3％,P＜0.01).Ce of propofol in the group D was lower than that in the group C(P＜0.01).HR af T1 in the group D was decreased;HR and MAP at T2 in the group C were decreased,which at T3 were increased.No intraoperative awareness occurred in all cases.Conclusion Pre-injection of DEX 1ug/kg before induction can decrease the propofol dose and maintains hemodynamic stability.