右旋美托咪定减少全身麻醉患者丙泊酚的用量

目的 观察不同剂量的右旋美托咪定（dexmedetomidine,Dex）对丙泊酚靶控输注（target controlled infusion,TCI）效应室浓度（effect-site concentration,Ce）及丙泊酚使用量的影响.方法 选择75例在全凭静脉麻醉下择期行腹腔镜单纯胆囊切除术的患者,将其采用数字表法随机分为3组,生理盐水（NS组）,右旋美托咪定0.4μg/kg（D1组）和右旋美托咪定0.5 μg/kg（D2组）,每组25例.各组在麻醉诱开始导前泵注完相应药物.同时所有患者均采用相同的麻醉诱导及维持方案.术中根据BIS数值调整丙泊酚血浆靶控浓度,分别于气管插管前（T.）、切皮前（T1）、气腹后1min（T2）、5min（T3）、10min（T4）、20min（T5）、放气腹后5min（T6）记录丙泊酚Ce,手术结束时记录丙泊酚所用总量.结果 NS组丙泊酚使用量显著高于D1组和D2组（P＜0.05,P＜0.01）.D1组在T2～T6时间点丙泊酚Ce显著低于NS组（T6时间点P＜0.05,其余时间点P＜0.01）,D2组各时间点丙泊酚Ce均显著低于NS组（P＜0.01）.使用0.4μg/kg和0.5μg/kg的右旋美托咪定分别节省丙泊酚21％和30％的用量.结论 全凭静脉麻醉应用右旋美托咪定可以显著降低术中丙泊酚效应室浓度,减少丙泊酚用量.

Dexmedetomidine Decreass the Dosage of Propofol in Patients Under General Anesthesia

Objective To evaluate effects of different doses of dexmedetomidine on effect-site concentration （Ce） of propofol with target controlled infusion （TCI） and the dosage of propofol.Methods Seventy-five patients undergoing laparoscopic cholecystectomy under target controlled infusion of propofol were randomly allocated to three groups with 25 patients in each.Dexmedetomidine 0.4μg/kg （group D1）,0.5μg/kg （group D2） and normal saline （group NS） was infused intravenously before the induction of anesthesia started.Meanwhile,all patients received the same method of induction and the maintenance of anesthesia.Propofol target concentration guided by the bispectral index （BIS）.Ce of propofol was recorded before endotracheal intubation （T0）,before skin incision （T1）,lmin after pneumoperitoneum （T2）,5min after pneumoperitoneum （T3）,10min after pneumoperitoneum （T4）,20min after pneumoperitoneum （T5）,the end of pneumoperitoneum after 5min （T6）.At the end of operation,the total dose of propofol was recorded.Results More propofol was consumed in group NS than that in group D1 and in group D2 （P ＜ 0.05）.In each time point,the propofol Ce in group D2 was significantly lower than group NS （P ＜ 0.01）.From T2 to T6,the propofol Ce in group D1 was significantly lower than group NS （T6 time point P ＜ 0.05,other time points P ＜ 0.01）.The dosage of propofol decreased by 21％ and 30％ respectively when combined with dexmedetomidine 0.4μg/kg and 0.5p g/kg.Conclusion Dexmedetomidine can significantly decrease the propofol Ce and reduce the consumption of propofol in total Intravenous Anesthesia.