右美托咪定2种剂量对靶控输注丙泊酚效应室浓度的影响

Effects of two doses of dexmedetomidine on effect-site concentration of propofol given by target-controlled infusion

目的以脑电双频指数(BIS)为麻醉镇静深度指标,探讨2种剂量右美托咪定静脉泵注对靶控输注丙泊酚效应室浓度的影响。方法妇科腹腔镜手术患者60例,ASAⅠ或Ⅱ级,随机分为3组,每组20例。右美托咪定Ⅰ组(D1组)及Ⅱ组(D2组)予右美托咪定0.3及0.6μg.kg-1,对照组(C组)予等容量氯化钠注射液,均以微量泵于麻醉诱导前在10 min内泵注完毕。3组麻醉诱导方法相同,术中根据BIS值调节丙泊酚血浆靶浓度维持麻醉。记录用药前、诱导前、插管前和后、切皮前、切皮后30 min、术毕及拔管后时间点的丙泊酚效应室浓度及血流动力学参数。并记录苏醒时间及不良反应的发生情况。结果 3组间麻醉时间、苏醒时间无显著差异(P>0.05),而丙泊酚用量差异非常显著(P<0.01),C组、D1组和D2组分别为(8.4±s 1.5)、(6.0±1.0)和(4.8±1.1)mg.kg-1.h-1。麻醉诱导及维持期间D1和D2组丙泊酚效应室浓度低于C组(P<0.01),且D2组低于D1组(P<0.05)。与C组相比,D1和D2组患者平均动脉压及心率波动较小。D2组术中发生心率减慢4例,予阿托品后好转,3组均未见严重不良反应发生。结论右美托咪定单次泵注可以降低靶控输注丙泊酚效应室浓度、减少丙泊酚用量,但剂量增大,术中心率减慢的发生率也相应增加。

AIM To investigate the effects of single intravenous infusion of two doses of dexmedetomidine on effect-site concentration of propofol by target-controlled infusion（TCI） with bispectral index（BIS） as the index of depth of anesthesia.METHODS Sixty patients undergoing laparoscopic gynecologic surgery,ASA Ⅰor Ⅱ,were randomly divided into three groups（n = 20）.Patients in the group D1,group D2 and group C were respectively administered with dexmedetomidine 0.3 μg.kg-1,0.6 μg.kg-1,or sodium chloride injection by micro-pump in 10 minutes before anesthesia induction.The patients in the three groups were under same anesthesia induction and the propofol target plasma concentration was adjusted according to BIS.Propofol effect-site concentration and hemodynamic changes were recorded before drug using,before induction of anesthesia,immediately before and after tracheal intubation,before skin incision,30 min after skin incision,at the end of operation and after extubation.Recovery time and adverse reactions were also recorded.RESULTS There was no difference among the three groups in anesthesia time and waking time（P 0.05）.But the doses of propofol were significantly different（P 0.01）,the group C,group D1 and group D2 were（8.4 ± s 1.5）,（6.0 ± 1.0）and（4.8 ± 1.1） mg.kg-1.h-1.The propofol effect-site concentration of group D1 and group D2 were lower than that in group C（P 0.01）,and group D2 were lower than group D1（P 0.05） during induction and maintenance of anesthesia.Compared with group C,MAP and HR fluctuations caused by tracheal intubation were well controlled in group D1 and group D2.There were four patients of group D2 occurred slowing in HR and had risen to an acceptable range after given atropine.There were no serious adverse reactions in the three groups.CONCLUSION The infusion of dexmedetomidine can make a reduction in propofol effect-site concentration to reduce the dosage of propofol.But as the dose increased,the incidence of intraoperative complications also increases accordingly.