右美托咪定对瑞芬太尼复合丙泊酚靶控输注全麻的影响

目的观察预先给予右美托咪定对瑞芬太尼复合丙泊酚靶控输注(TCI)全麻的影响。方法择期全麻行妇科腹腔镜手术患者40例,随机均分为右美托咪定组(D组)和对照组(C组),D组诱导前15min静脉泵注右美托咪定0.8μg/kg,C组则给予等量生理盐水。观察注药前(T1)、麻醉诱导前(T2)、插管前即刻(T3)、插管后即刻(T4)、插管后3min(T5)、拔管后即刻(T6)、拔管后3min(T7)的BIS、MAP、HR、肾上腺素(E)、去甲肾上腺素(NE)浓度变化;记录丙泊酚和瑞芬太尼的用量、麻醉恢复情况,随访术后延迟性呼吸抑制、术中知晓情况。结果 T2时D组BIS明显低于T1时和C组(P<0.01);与D组比较,T2、T4、T6时C组MAP明显升高,HR明显增快(P<0.05或P<0.01);T4、T6时C组的E、NE浓度明显高于T3时和D组(P<0.01),而D组则无明显变化;D组丙泊酚和瑞芬太尼的用量明显少于C组(P<0.05);D组拔管期间体动、呛咳的发生率明显低于C组(P<0.01),两组呼吸恢复时间、睁眼时间、拔管时间组间差异无统计学意义。结论瑞芬太尼复合丙泊酚靶控输注全麻预先静注右美托咪定0.8μg/kg可产生明显的镇静效应,有效抑制患者的应激反应,减少麻醉药的用量,且不延长麻醉恢复时间。

Clinical evaluation of dexmedetomidine in anesthesia with target controlled infusion of propofol and remifentanil

Objective To observe the influence of pre-injection of dexmedetomidine (Dex) on anesthetic effects in patients undergoing target controlled infusion (TCI) of propofol and remifentanil. Methods Forty female patients scheduled for gynecological laparoscopy were randomly assigned to two groups: dexmedetomidine group (group D)and control group(group C). In group D the patiens received Dex 0.8μg/kg i.v. within 15 min.In group C received equal volume of saline.Bispectral index (BIS), MAP, HR and the values of norepinephrine (NE) and epinephrine (E) were recorded at the time points of pre-administration of Dex (T1), before induction (T2), pre-intubation (T3), intubation (T4), 3 min after intubation (T5), extubation (T6), 3 min after extubation (T7). Anesthetics consumption, anesthesia recovery, delayed respiratory depression and intraoperative awareness were recorded as well. Results Compared to those at T1 and group C, BIS scale of group D at T2 showed significant decrease (P<0.01). MAP, HR in group C had a significant increase than those in the group D at T2,T4,T6 (P<0.05 or P<0.01). In group C, the values of NE and E were significantly higher at T4,T6 than those at T3 and group D(P<0.01). The values of NE and E in group C at T4,T6 had a significant increase compared with those values in group D (P<0.01). Propofol and remifentanil consumption in group D were less than in group C (P<0.05). Incidence of body movement and coughing before extubation was higher in group C than those in group D (P<0.01). There was no significant difference in the recovery time and eye opening with trachel extubation time from anesthesia between the two groups. Conclusion During anesthesia with TCI of propofol and remifentanil, sedative effect can be induced by dexmeditomidine 0.8 μg/kg, which can reduce stress responses and anesthetics consumption without extended recovery time from anesthesia.