右美托咪定对丙泊酚复合瑞芬太尼麻醉下脑功能区手术患者唤醒试验质量的影响

Effect of dexmedetomidine on intraoperative wake-up test during cerebral functional area operation performed under combined intravenous propofol-remifentanil anesthesia

目的评价右美托咪定对丙泊酚复合瑞芬太尼麻醉下脑功能区手术患者唤醒试验质量的影响。方法拟行术中唤醒的脑功能区手术患者27例，性别不限，年龄17～43岁，BMI20～24kg／m2，ASA分级I或Ⅱ级，采用随机数字表法，将患者随机分为2组：对照组（c组，n=13）和右美托咪定组（D组，n=14）。麻醉诱导后气管插管，麻醉维持：2组均靶控输注丙泊酚和瑞芬太尼，丙泊酚血浆靶浓度3～5μg／ml，调整丙泊酚血浆靶浓度维持BIS值55～65，瑞芬太尼效应室靶浓度2～6ng／ml。打开硬脑膜后，D组停止输注丙泊酚和瑞芬太尼，经15min静脉输注右美托咪定负荷量0．3μg／kg，随后以0．2／μg·kg-1·h-1速率维持；C组打开硬脑膜后15min将丙泊酚血浆靶浓度降至0．5μg／ml，将瑞芬太尼效应室靶浓度降至0．5ng／ml。记录唤醒时间、唤醒试验期间心血管事件、头痛、躁动、谵妄和术中知晓等的发生情况。结果所有患者均成功实施唤醒，并顺利完成手术。与c组比较，D组唤醒试验期间高血压、心动过速、头痛和术中知晓的发生率均降低（P〈0．05），唤醒时间差异无统计学意义（P〉0．05），2组未见躁动和谵妄的发生。结论右美托咪定可提高丙泊酚复合瑞芬太尼麻醉下脑功能区手术患者唤醒试验的质量。

Objective To evatluate the effect of dexmedetomidine on intraoperative wake-up test during cerebral functional area operation performed under combined iv propofol-remifentanil anesthesia. Methods Twenty-seven ASA Ⅰ orⅡpatients （both sexes） aged 17-43 yr with a body mass index of 20-24 kg/m2 undergoing operation on cerebral functional area during which intraoperative wake-up test was performed were randomly divided into control group （group C, n = 13） and dexmedetomidine group （group D, n = 14）. Anesthesia was induced with midazolam, snfentani], etomidate and rocuronium and maintained with TCI of pr0Pofol （Cp = 3-5 μg/ml） and remifentanil （Ce = 2-6 ng/ml）. BIS value was maintained at 55-65. In group D after dura of brain was opened, a loading dose of dexmedetomidine 0.3 gg/kg was administered iv over 15 min followed by continuous iv infusion at O. 2 μg.kg- 1.h- 1 while TCI of propofol and remifentanil were suspended. In group C after opening of dura, Cp of propofol TCI was reduced to 0.5 μg/ml and Ce of remifentanil to 0.5 ng/ml. The wake-up time and development of hypertension, tachycardia, headache, dysphoria, delirium and awareness were recorded. Results All patients were successfully awakened. There was no significant difference in wake-up time between the 2 groups （ P 〉 0.05）. The incidences of hypertension, tachycardia, headache and awareness were significantly lower in group D than in group C （ P 〈 0.05） . Conclusion Dexmedetomidine does not affect intraoperative wake-up time during operation on cerebral functional area performed under iv propofol-remifentanil anesthesia, but can significantly reduce the incidence of adverse effects.