右旋美托咪定减少丙泊酚和芬太尼的用量及对麻醉恢复期的影响

Influences of dexmedetomidine in doses of propofol and fentanyl and recovery from anesthesia

目的:探讨右旋美托咪定(Dex)减少丙泊酚和芬太尼的用量、抑制气管插管和拔管的应激反应以及对麻醉恢复期的影响。方法:选择24例择期手术全麻患者(ASAⅠ～Ⅱ级),将患者随机分成Dex组和对照组,每组各12例。全麻诱导前30min Dex组以1μg.kg-1 Dex稀释成10mL、对照组以生理盐水分别静脉泵注10min。丙泊酚0.4mg.kg-1.min-1泵注开始诱导,直至患者托下颌无体动时静注芬太尼1μg.kg-1和爱可松0.6mg.kg-1,1.5min后进行气管内插管。插管成功后停丙泊酚吸入七氟醚,Dex组给予Dex 0.3μg.kg-1.h-1直至手术结束,对照组给予同等容量的生理盐水。手术结束时停用七氟醚,记录患者丙泊酚诱导量和芬太尼总用量,记录患者入室时(T0)、置入喉镜时(T1)、置入气管导管时(T2)、手术后睁眼时(T3)、拔管时(T4)、拔管后10min(T5)的心率(HR)和平均动脉压(MAP),记录术后呼吸恢复时间、睁眼时间和拔管时间。结果:与对照组比较,Dex组的丙泊酚诱导量(mg.kg-1)减少了21%(P<0.01),芬太尼总用量减少了38%(P<0.01);对照组在T1、T2、T4的MAP和HR与基础值T0比较明显升高(P<0.01),Dex组T1～T6的MAP、HR与基础值T0比较则无明显变化;Dex组在T1、T2、T4的MAP和HR与对照组比较明显降低(P<0.01)。结论:Dex可减少丙泊酚诱导量和术中芬太尼用量,维持气管插管和拔管期间血流动力学稳定,同时对麻醉恢复期没有影响。

Objective To evaluate the potential sparing effects of dexmedetomidine（Dex） on propofol and fentanyl and suppression of sympathoadrenal responses to tracheal intubation and extubation and the influence in recovery from anesthesia.Methods A total of 24 patients（ASA Ⅰ-Ⅱ） undergoing selective operation practicing general anesthesia were randomly divided into 2 groups：Dex group（n=12） and control group（n=12）.30 min before induction the patients in Dex group received 1 μg·kg-1 Dex diluted to 10 mL over 10 min by pumped infusion and the patients in control group simply recieved normal saline at the same way.The patients in both groups were pumped 0.4 mg·kg-1·min-1 propofol at the beginning of induction.When holding up jaw without bodymove,the patients received 1 μg·kg-1 fentanyl and 0.6 mg·kg-1 rocuronium,and were endotracheally intubated 1.5 min later.After being intubated successfully they received sevoflurane by inhalation instead of propofol.At the same time the patients in Dex group received 0.3 μg·kg-1·h-1 Dex till the operation finished and the patients in control group received normal saline at the same way.Sevoflurane ceased at the end of surgery.The dose of propofol duing induction and fentanyl during the entire operation were recorded.The HR and MAP of the patients were recorded when they entering the operation room（T0）,being inserted laryngoscopy（T1）,being endotracheally intubated（T2）,opening their eyes after operation（T3）,being extubated（T4） and 10 min after being extubated（T5）.The postoperative respiration recovery time,time to open eyes and extubation time after operation were recorded.Results Compared with control group,the dose of propofol（mg·kg-1） during inducion was decreased by 21%（P0.01）and the dose of fentanyl during the entire operation was decreased by 38% in Dex group（P0.01）.The MAP and HR in control group were rised significantly at T1,T2 and T4 compared with T0（P0.01）.The MAP and HR at T1-T6 in Dex group had no significant change compared with T0.The MAP and HR in Dex group were decreased obviously at T1,T2 and T4 compared with control group（P0.01）.The postoperative respiration recovery time,time to open eyes and extubation time had no significantly difference between two groups（P0.05）.Conclusion Dex may reduce the dose of propofol duing induction and fentanyl during the entire operation and have hemodynamic-stabilizing effects during tracheal intubation and extubation while not prolonging the recovery time from anesthesia.