右美托咪定在腹腔镜下肝部分切除术中的应用

目的]探讨不同剂量右美托咪定用于腹腔镜下肝部分切除术的安全性和有效性。方法] 美国麻醉师协会(ASA)分级为Ⅱ或Ⅲ级择期行腹腔镜肝部分切除术患者60例,随机分为两组,一组静脉泵注右美托咪定负荷剂量0.2 μg/kg(10 min注完),继以0.2 μg/(kg·h)维持泵注至手术结束前30 min(D1组),另一组静脉泵注右美托咪定负荷剂量0.2 μg/kg(10 min注完),继以0.5 μg/(kg·h)维持泵注至手术结束前30 min(D2组)。两组术中用七氟烷、丙泊酚维持麻醉,观察记录输注右美托咪定前(T0)、输注右美托咪定10 min后(T1)、气管插管即刻(T2)、气管插管后1 min(T3)、气管拔管即刻(T4)患者的收缩压、舒张压、心率、血氧饱和度,以及术后呼吸恢复时间、睁眼时间、拔管时间和躁动例数。结果] 与入手术室时对比,两组患者在插管前、后和拔管时血压、心率无明显差异,D2组患者术后呼吸恢复时间、睁眼时间、拔管时间均较D1组长(P<0.05)。结论] 0.2 μg/(kg·h)右美托咪定维持泵注可使腹腔镜肝部分切除术患者的血流动力学更稳定,术后苏醒更迅速完全。

Dexmedetomidine applied in laparoscopic partial hepatectomy

Objective] To explore the safety and effectiveness of Dexmedetomidine （ Dex） at dif-ferent doses used in laparoscopic partial hepatectomy . Methods] A total of 60 patients （ ASA II orⅢmagnitude ） who received elective laparoscopic partial hepatectomy were randomly divided into Group D 1 and Group D2.Group D1 received vein pump injection dose of Dex load 0.2 μg/kg （10 min after injec-tion）, and was followed by pump injection of 0.2μg/（kg· h） for 30 min before the end of surgery.Group D2 received vein pump injection dose of Dex load 0.2μg/kg （10 min after injection）, and was followed by pump injection of 0.5 μg/（ kg· h） for 30 min before the end of surgery .The patients in two groups were both given sevoflurane and propofol to maintain anesthesia in surgery and observed and recorded systolic and diastolic pressure ,heart rate ,oxygen saturation of blood ,postoperative respiratory recovery time , eye-open-ing time, extubation time and the number of agitation before infusion with Dexmedetomidine （ T0 ） , at 10 minutes after infusion of Dexmedetomidine （ T1 ） , endotracheal intubation immediately （ T2 ） , 1 min after endotracheal intubation（T3）, and endotracheal tube being drawn immediately （T4）. Results] Com-paring with those at the time of entering the operation room , blood pressure and heart rate in the two groups before and after intubation and at the extubation time were not significantly different （P〉0.05）.The respi-ratorg recovery time ,eye-opening time and extubation time of group D 2 were longer than those of group D 1 （P〈0.05）. Conclusion] With maintained pump infusion of Dex at dose of 0.2 μg/（kg· h）,pa-tients undergoing laparoscopic partial hepatectomy have more stable hemodynamics and revive more quickly and completely after operation .