右旋美托咪啶全凭静脉麻醉对肥胖患者的影响

Impact of Dexmedetomidine total intravenous anaesthesia on obese patients

目的 比较右旋美托咪啶和瑞芬太尼全凭静脉麻醉对乳腺癌改良根治术肥胖患者循环功能、麻醉镇痛药物、麻醉恢复和不良反应的影响.方法 56例ASAⅠ～Ⅱ级择期全麻下行乳腺癌改良根治术的肥胖病人（34～60岁）纳入此次前瞻、随机、双肓临床研究.患者随机分配入右旋美托咪啶组或瑞芬太尼组,每组28例.右旋美托咪啶组麻酢诱导前给予负荷量1μg/kg（15 min内）,继而以0.2～1μg/（kg·h）持续输注;瑞芬太尼组给予负荷量1 μg/kg（15min内）,继而以0.05～1 μg/（kg·min）持续输注.配伍丙泊酚和肌松药维持全麻.记录术中血流动力学变化、麻醉镇痛药物的使用量,观察麻醉恢复时间及术后不良反应的发生率.结果 两组患者平均动脉压比较差异无显著性（P〉0.05）;但瑞芬太尼组拔管时心率明显增快,差异有显著性（P〈0.05）.右旋美托咪啶组丙泊酚的诱导和维持剂量减少,术毕追加镇痛药的时间延长,术后呼吸抑制、恶心呕吐和寒战的发生率降低,与瑞芬太尼组比较差异有显著性（P〈0.05）,但麻醉苏醒时间的各项指标延长（P〈0.05）.两组心动过缓的发生率差异无显著性（P〉0.05）.结论 右旋美托咪啶全凭静脉麻醉能为肥胖患者乳腺癌手术提供比较平稳的血流动力学,同时减少丙泊酚的使用量,延长追加镇痛药的时间,减少不良反应,但麻醉苏醒时间延长.

Objective To compare the impact on the circulation function and anesthetic recovery between the obese perioperative patients with elective modi？ed radical mastectomy received dexmedetomidine total intravenous anaesthesia and the ones received remifentanil total intravenous anaesthesia; and to explore the anti-pain effect and side-effects of the two group patients. Methods In this prospective randomized double-blind study, 56 cases ASA Ⅰ～Ⅱ and age 34 ～ 60yr morbidly obese patients who were scheduled for modi？ed radical mastectomy, were allocated into two groups averagely.Dexmedetomidine group received i.v. dexmedetomidine 1 μ g/kg as preinduction within 15 minutes, then muscular to maintain anaesthesia. Record hemodynamics changes and anaesthesia drug dose during the operation. Record the anaesthetic recovery time, and observe the postoperative adverse reaction. Results Propofol-remifentanil and propofol-dexmedetomidine got similar intraoperative hemodynamic responses;the mean arterial pressure was similar in the two groups（P〉0.05）, but heart rate was higher after extubation in remifentanil group （P〈 0.05）. Propofol doses for induction and maintenance of anesthesia was lower within dexmedetomidine group. The need for earliest analgesic administration was delayed, and the incidence rate of postoperative respiratory depression, nausea, vomiting, shivering were lower in dexmedetomidine group （P〈0.05）; but the recovery time was longer（P〈0.05）. Bradycardia was similar between two groups （P〉 0.05）. Conclusion Dexmedetomidine total intravenous anesthesia provide stable hemodynamics for the morbidly obese patients with elective modi？ed radical mastectomy; and can decrease propofol consumption and undesirable side-effects, delay postoperative analgesics requirement, but it fail to facilitate anesthetic recovery.