右旋美托咪定在全麻诱导中的镇静效应及对丙泊酚用量的影响

Sedation efficacy of dexmedetomidine and its influence on requirement of propofol during anesthesia induction

目的观察右旋美托咪定(dexmedetomidine,DM)在全麻诱导中的镇静效应及对丙泊酚用量的影响。方法选择40例全麻患者随机均分为两组:D组以DM 1μg/kg稀释成10ml静脉泵注8min;C组以生理盐水为对照分别。给药后20min开始泵注丙泊酚0.4mg.kg-1.min-1,芬太尼1-2μg/kg和维库溴铵0.8-1.0mg/kg。记录用DM前(T0)、用DM后3min(T1)、6min(T2)、9min(T3)、18min(T4)以及插管前(T5)、插管结束后1min(T6)、插管结束后3min(T7)的脑电双频谱指数(BIS)、MAP和HR。记录诱导期丙泊酚用量。结果与T0比较,D组T3和T4时的BIS值从94.6±2.7分别下降至84.9±9.0(P<0.05)和71.7±11.6(P<0.01)。D组T6和T7时BIS值略低于对照组(34.1±6.9和38.0±8.1vs.43.0±27.3和40.7±9.7)。与T0比较,D组T4时HR明显降低[(67.7±16.0)次/分vs.(57.2±11.6)次/分](P<0.01);与T5比较,D组T6、T7时的MAP和HR均无显著性变化(P>0.05)。与T5相比,C组T6和T7时的MAP均明显升高[(77.3±13.5)mm Hg vs.(94.4±20.0)mm Hg和(92.4±14.8)mm Hg](P<0.01)。D组丙泊酚最小诱导量和丙泊酚诱导总量均明显低于C组[(1.4±0.3)mg/kg vs.(2.4±0.3)mg/kg和(3.3±0.3)mg/kg vs.(4.5±0.2)mg/kg](P<0.01)。结论麻醉诱导前用DM 1μg/kg可以产生明显的镇静效应,减少诱导时丙泊酚用量,无呼吸抑制作用。

Objective To observe the of dexmedetomidine（DM） and its influence on requirement of propofol during anesthesia induction.Methods Forty patients undergoing general anesthesia were equally randomized into two groups of D（DM 1 μg/kg infused at 20 min before anesthesia induction） and C（infusion of normal saline instead of DM）.Anesthesia induction was performed with propofol 0.4 mg·kg-1 ·min-1,fentanyl 1-2 μg/kg and vecuronium 0.8-1.0 mg/kg.Bispectral index（BIS）,heart rate（HR） and mean arterial pressure（MAP） were recorded before（T0） and at 3（T1）,6（T2）,9（T3） and 18（T4） minutes after DM infusion,before intubation（T5） and at 1（T6） and 3（T7） minutes after intubation.The minimum dose and total amount of propofol during induction were calculated.Results Compared to T0,BIS values of group D were dectreased at T3 and T4（94.6±2.7 vs.84.9±9.0 and 71.7±11.6）（P〈0.05 and P〈0.01）.BIS values of group D at T6 and T7 were slightly lower than those of group C（34.1±6.9 vs.43.0±27.3 and 38.0±8.1 vs.40.7±9.7）.Compared to T0,HR of group D was decreased at T4[（67.7±16.0） beats/min vs.（57.2±11.6） beats/min]（P〈0.01）.Compared to T5,MAP and HR of group D at T6 and T7 were not significantly changed（P〉0.05）.Compared to T5,MAP of group C at T6 and T7 was increased[（77.3±13.5） mm Hg vs.（94.4±20.0） mm Hg and（92.4±14.8） mm Hg（P〈0.01）.The minimum dose and the total amount of propofol during induction were less in group D than those in group C [（1.4±0.3） mg/kg vs.（2.4±0.3） mg/kg and（3.3±0.3） mg/kg vs.（4.5±0.2） mg/kg]（P〈0.01）.ConclusionDM 1 μg/kg infused before anesthesia induction can enhance the sadation,reduce the requirement of propofol without respiratory depression.