不同剂量右美托咪啶复合丙泊酚全凭静脉麻醉用于妇科腹腔镜手术的临床观察

Clinical Observation of Different Doses of Dexmedetomidine Combined Propofol in Total Intravenous Anesthesia for Gynecological Laparoscopic Surgery

目的观察不同剂量右美托咪啶(DEX)对丙泊酚血浆靶控浓度(Ct)及血流动力学影响。方法选择妇科腹腔镜手术45例(ASAⅠ～Ⅱ级),随机分3组:D1组、D2组和C组,各15例。诱导前D1组和D2组分别以0.4μg/kg DEX和0.8μg/kg DEX稀释成10 mL,C组以10 mL生理盐水泵注10 min。3组麻醉诱导维持方法相同,术中根据脑电双频指数(BIS)值调节Ct维持麻醉深度。记录入室(T0)、泵药后(T1)、诱导前(T2)、插管前后(T3、T4)、切皮前(T5)、切皮后30 min(T6)、术毕(T7)、苏醒时(T8)、拔管即刻(T9)、拔管后1 min(T10)、5 min(T11)、15 min(T12)的MAP、HR、BIS、Ct,麻醉诱导后、切皮后30 min内及总丙泊酚用量,心肌氧耗指数(RPP)。结果 D1组和D2组T3至T7时与C组比较差异具有统计学意义(P<0.05),D1组与D2组比较差异具有统计学意义(P<0.05)。结论 DEX麻醉诱导前单次泵注能降低Ct,大量减少丙泊酚用量。血流动力学更为稳定。但是随着剂量增大,术中心率减慢发生率相应增加,术后嗜睡发生率也相应增加。

Objective To observe the effects of different doses of dexmedetomidine （DEX） on hemodynamics and target-controlled plasma concentration of propofol （Ct）. Methods A total of 45 patients （ASA I-II ） undergoing gynecological laparoscopic surgery were randomly divided into 3 groups：D1 group（n =15）,D2 group（n =15）,C group（n =15）.The patients in D1 group and D2 group received 0.4 μg/kg DEX and 0.8 μg/kg DEX respectively which were diluted to 10 mL before anesthesial induction. The C group simply received 10 mL saline by pumped infusion for 10 min. The ways of anesthesia induction and anesthesia maintenance in the three group were the same. The plasma concentration of propofol was regulated to maintain the depth of anesthesia according to bispectral index （BIS） values. The MAP, HR and BIS of patients were recorded when entering the operative room（T0 ）, after administration of drugs（T1 ）, before anesthesia induction（T2 ）, be- fore and after tracheal intubation （ T3, T4 ）, before skin incision （ T5 ）, 30 rain after skin incision （ T6 ）, ending of surgery （ T7 ）, waking up （ T8 ）, extubation（T9）, 1 min after extubation （T10）, 5 rain after extubation（T11 ） and 15 rain after extubation（T12）.The total propofol dose and the myocardial oxygen consumption index were also recorded. Results Compared to C group,the differences of D1 group＇s Ct and D2 group＇s Ct from T3 to T7 were statistically significant（P 〈 0.05 ）. Also, the difference between D2 group and D1 group was statistically significant （P 〈 0.05 ）. Conclusion A single infusion of dexmedetomidine before anesthesia induction can reduce propofol＇s target-controlled plasma con- centration and its medication dosage. And DEX can maintain hemodynamicly stable. However,the incidence of intraoperative bradycardia could increase as the dose of DEX increases, so as the postoperative drowsiness.