右美托咪定微量泵输注用于气管插管全麻手术麻醉诱导的临床观察

目的：探讨微量泵输注右美托咪定用于气管插管全麻手术麻醉诱导的可行性及对气管插管时血流动力学变化的影响,并确定诱导时右美托咪定的最佳使用剂量。方法：ASA分级Ⅰ～Ⅱ级、择期行腹腔镜手术的患者60例,将其随机分成3组,每组20例,Ⅰ、Ⅱ、Ⅲ组分别在诱导开始时采用微量泵输注右美托咪定0.5、1.0、1.5μg/kg,输注时间为10 min。输注5min后开始静脉注射丙泊酚1.5 mg/kg、芬太尼4μg/kg、阿曲库铵0.15 mg/kg,于输注右美托咪定10 min后行插管。观察诱导前（T0）、气管插管前（T1）、插管即刻（T2）及插管后1 min（T3）、5 min（T4）的平均动脉压（MAP）和心率（HR）。结果：T0时3组HR和MAP差异均无统计学意义（P〉0.05）。T1时Ⅰ、Ⅱ、Ⅲ组HR均较T0有显著降低（P〈0.05）,其中Ⅲ组降低更为显著（P〈0.01）,与Ⅰ、Ⅱ组比较,差异有统计学意义（P〈0.05）;Ⅰ、Ⅱ组MAP变化不大（P〉0.05）,Ⅲ组MAP较T0有显著降低（P〈0.05）,与Ⅰ、Ⅱ组比较,差异有统计学意义（P〈0.05）。T2时Ⅰ组MAP、HR升高显著,与T1比较,差异有统计学意义（P〈0.05）,与Ⅱ组比较,差异亦有统计学意义（P〈0.05）,Ⅱ、Ⅲ组MAP、HR与T1比较,差异无统计学意义（P〉0.05）。T3时Ⅰ组HR和MAP较T1有显著上升（P〈0.05）,Ⅱ组和Ⅲ组HR和MAP较T1无显著变化（P〉0.05）。T4与T0比较,3组MAP及HR差异均无统计学意义（P〉0.05）。结论：微量泵持续输注右美托咪定诱导法可安全地应用于临床,三种方案中以1.0μg/kg输注右美托咪定,在整个诱导、插管期间血流动力学变化较稳定,可作为最佳使用剂量推荐给临床。

Clinical observation of dexmedetomidine administered with a micro infusion pump on endotracheal intubation during general anesthesia induction

Objective：To study the feasibility of dexmedetomidine administered with a micro infusion pump on endotracheal intubation and effect of dexmedetomidine administered with a micro infusion pump on hemodynamics change during general anesthesia induction.To determine the best dose of dexmedetomidine during general anesthesia induction.Methods：60 patients（ASAⅠ～Ⅱ）,who needed laparoscopic surgery,were randomly divided into three groups（n=20）.0.5,1.0,1.5 μg/kg dexmedetomidine was respectively injected with a micro infusion pump in theⅠ,Ⅱ,Ⅲ group,infusion time was 10 minutes.1.5 mg/kg propofol,4 μg/kg fentanyl and 0.15 mg/kg atracurium were injected intravenously after dexmedetomidine was injected 5 minutes.Endotracheal intubation was placed after dexmedetomidine was injected 10 minutes.Mean arterial pressure（MAP） and heart rate（HR） were measured before induction（T0）,before intubation（T1）,instant time after intubation（T2） and 1 minute（T3）,5 minutes（T4） after intubation.Results：There was no significant difference in HR and MAP at T0 in the three groups（P0.05）.HR at T1 significantly decreased than that at T0 in theⅠ,Ⅱ and Ⅲ groups（P0.05） and the decrease of HR in the Ⅲ group was most significant（P0.01）.HR at T1 in the Ⅲ group significantly decreased than that in the Ⅰ and Ⅱ groups（P0.05）.MAP at T1 did not change in the Ⅰ and Ⅱ groups（P0.05）.MAP at T1 significantly decreased than that at T0 in the Ⅲ group（P0.05）,and MAP at T1 in the Ⅲ group significantly decreased than that in the Ⅰ and Ⅱ groups（P0.05）.HR and MAP at T2 significantly increased compared with at T1 in the Ⅰ group（P0.05）,and HR and MAP at T2 in the Ⅰ group significantly increased than that in the Ⅱ group（P0.05）.There was no significant difference in MAP and HR at T2 than that at T1 in theⅡ and Ⅲ groups（P0.05）.HR and MAP at T3 significantly increased compared with that at T1 in the Ⅰ group（P0.05）,and there was no significant difference in HR and MAP at T3 compared with that at T1 in the Ⅱ and Ⅲ groups（P0.05）.There was no significant difference in HR and MAP at T4 compared with that at T0 in the Ⅱ and Ⅲ groups（P0.05）.Conclusion：Anesthesia induction by dexmedetomidine administered with a micro infusion pump can be safely used in clinical,and hemodynamics is the most stable when 1.0 μg/kg dexmedetomidine is administered with a micro infusion pump in phase of induction and intubation in the three groups.1.0 μg/kg dexmedetomidine can be recommended as the best dose for clinical use.