Objective To investigate the effects of different loading doses of dexmedetomidine medication before surgery on palinesthesia quality of patients receiving laparoscopic cholecystectomy. Methods A total of 120 patients ( ASA class Ⅰ or Ⅱ) who were scheduled for laparoscopic cholecystectomy under general anesthesia were randomly divided into four groups: group D1, group D2, group D3 and group NS, with 30 cases in each group. The patients in group D1, group D2, group D3 were given a loading dose 0. 3μg/kg,0. 5μg/kg,1. 0μg/kg of dexmedetomidine,respectively,however,the patients in group NS were given the same volume of 0. 9% sodium chloride solution via a pump within 15 minutes before anesthesia. The spontaneous breathing recovery time, eye opening time, extubation time, PACU stay time were recorded, moreover, the Ramsay sedation scores during palinesthesia period, VAS pain score, choking cough score and adverse reactions were observed. In addition the changes of mean aerial pressure ( MAP) and heart rate ( HR) were observed before anesthesia (T0),at the end of surgery (T1), at tracheal extubation (T2),at extubation after 5 minutes (T3) and out of anesthetic recovery room (T4). Results There were no significant differences in gender, age, body height and weight, anesthesia time and operation time among the four groups (P>0. 05). As compared with those before drug administration, MAP and HR at T2 in group D1 and group NS were significantly increased (P<0. 01), but the changes of MAP and HR T1, T2, T3, T4 in group D2 and group D3 were not significant (P>0. 05). Moreover there were no significant differences in MAP and HR in different time pionts between group D1 and group NS (P>0. 05),however,the MAP and HR in group D2 and group D3 were significantly decreased,as compared with those in group NS (P<0. 05). There were no significant differences in spontaneous breathing recovery time, eye opening time, extubation time between D1group ,D2 group and group NS(P>0. 05),and the PACU retention time was shorter in group D2,however, which in group D3 in corresponding time points was prolonged. In addition the Ramsay scores at 10min after extubation in group D3 were significantly higher than those in the other three groups, and VAS scores in group D2 and group D3 were significantly lower than those in group NS and group D1(P<0. 05). Besides the bucking scores and incidence rate of restless in group D2 and group D3 were significantly lower than those in group NS and group D1(P <0. 05). Conclusion A single loading dose of 0. 5μg/kg or 1. 0μg/kg dexmedetomidine medication before induction of anesthesia is able to effectively inhibit the hemodynamic response during extubation ,but 0. 5μg/kg dose can provide a better recovery quality,with fewer side effects of drugs,without effects on recovery time, therefor, which is an ideal dose for laparoscopic cholecystectomy.%目的 观察术前给予不同负荷剂量右美托咪定对全麻腹腔镜胆囊切除术患者苏醒质量的影响.方法 选择美国麻醉师协会( ASA)分级Ⅰ~Ⅱ级择期在全身麻醉下行腹腔镜胆囊切除术患者120例,按随机数字表法随机分为D1、D2、D3、NS组,每组30例,在麻醉诱导前15 min D1、D2、D3组分别泵注右美托咪定0. 3、0. 5、1. 0 μg/kg,NS组泵注等容量0. 9%氯化钠溶液,15 min内泵注完毕.记录4组患者自主呼吸恢复时间、睁眼时间、拔管时间、麻醉恢复室停留时间;记录苏醒期的Ramsay镇静评分、礼堂模拟(VAS)疼痛评分、呛咳评分、不良反应及麻醉给药前(T0)、手术结束时(T1)、拔管即刻(T2)、拔管后5 min(T3)、出麻醉恢复室(T4)的平均动脉压(MAP)、心率(HR)变化.结果 与给药前比较,NS组、D1组在T2时MAP和HR均显著升高(P<0. 01),而D2组、D3组MAP和HR变化不明显(P>0. 05);D1组MAP和HR在各时段与NS组差异无统计学意义(P>0. 05),而D2、D3组相比NS组MAP和HR均下降(P<0. 05). D1、D2组自主呼吸恢复时间、睁眼时间、拔管时间与NS组比较差异均无统计学意义(P>0. 05),但D2组可缩短PACU停留时间,而D3组各对应点时间均有延长. D3组拔管10 min后Ramsay评分高于其他3组, D2、D3组的VAS评分低于NS和D1组(P<0. 05).围拔管期间,D2、D3组的呛咳评分和躁动发生率明显低于NS组和D1组(P<0. 05).结论 麻醉诱导前单次给予0. 5 μg/kg或1. 0 μg/kg的负荷剂量右美托咪定均能够有效的抑制围拔管期的血流动力学反应,但0. 5 μg/kg剂量组的苏醒质量更高,且不影响苏醒时间,是LC较为理想的单次负荷用药剂量.
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