右美托咪啶对靶控输注丙泊酚镇静时量效关系的影响

Effect of Dexmedetomidine on dose-response relationship at different sedation level during target-controlled infusion of Propofol

目的探讨丙泊酚镇静时应用右美托咪啶对不同镇静水平所需丙泊酚效应室浓度的影响。方法普外科需接受全身麻醉择期手术120例。男48例,女72例;年龄20～50岁;体质量41～68 kg;ASA分级Ⅰ或Ⅱ级。将患者随机分为3组:丙泊酚组(P组)、右美托咪啶0.5μg/kg+丙泊酚组(D0.5P组)和右美托咪啶1.0μg/kg+丙泊酚组(D1.0P组),每组40例。D0.5P和D1.0P组分别用微量泵输注右美托咪啶0.5μg/kg和1.0μg/kg,泵注持续时间为10 min,P组则以相同的时间泵注生理盐水,将3组内患者随机分为5个亚组,每亚组8例,在输注右美托咪啶或生理盐水结束后5 min,效应室靶控丙泊酚,血浆效应室浓度分别设定为0、1、2、3和4 mg/L,3min后记录患者OAA/S评分。结果 3组间性别比、年龄和体质量差异无统计学意义(P>0.05)。OAA/S评分为3时,D0.5P和D1.0P组丙泊酚EC50为1.3 mg/L和0.7 mg/L,小于P组EC502.5 mg/L,差异具有统计学意义(P<0.0167),OAA/S评分为2即意识消失时,D0.5P和D1.0P组丙泊酚EC50为2.0 mg/L和1.3 mg/L,小于P组EC503.2 mg/L,差异具有统计学意义(P<0.0167),当OAA/S评分为1时,P、D0.5P和D1.0P组丙泊酚EC50分别为3.8、2.9和2.2 mg/L,D1.0P组EC50小于P组,差异具有统计学意义(P<0.0167)。结论静脉注射右美托咪啶0.5μg/kg和1.0μg/kg能降低不同镇静水平所需的丙泊酚效应室浓度。

【Objective】 To explore the effect of Dexmedetomidine on effect-site concentration of Propofol at different sedation level during Propofol administration.【Methods】 One hundred and twenty ASA Ⅰ or Ⅱ patients aged 20 ~50 yr weighing 41 ~68 kg scheduled for general surgery were randomly allocated to three groups： Propofol group（group P）,Dexmedetomidine 0.5 μg/kg ＋ Propofol group（group D 0.5 P） and Dexmedetomidine 1.0 μg/kg ＋ Propofol group（group D 1.0 P）.Dexmedetomidine 0.5 and 1.0 μg/kg and saline were intravenously infused for 10 minutes in group D 0.5 P,D 1.0 P and P,respectively.Patients in each group were randomly assigned to five subgroups（8 in each）： P0~4,D 0.5 P0~4 and D 1.0 P0~4.Five minutes after Dexmedetomidine and saline infusion finished,Propofol was effective-site target controlled infusion and the concentration was set at 0,1,2,3 and 4 mg/L,respectively.Three minutes later,OAA/S score was recorded.【Results】 There was no difference in the ratio of male/female,age and weight between groups（P〈 0.05）.At the time of OAA/S value was 3,Propofol EC 50 in group P,D 0.5 P and D 1.0 P were 2.5,1.3 and 0.7 mg/L,respectively.EC 50 in group D 0.5 P and D 1.0 P were significantly lower than that in group P（P〈 0.0167）.At the time of OAA/S value 2,Propofol EC 50 in group P,M 0.5 P and D 1.0 P were 3.2,2.0 and 1.3 mg/L,respectively.EC 50 in group D 0.5 P and D 1.0 P were significantly lower than that in group P（P〈 0.0167）.At the time of OAA/S value 1,Propofol EC 50 in group P,D 0.5 P and D 1.0 P were 3.8,2.9 and 2.2 mg/L,respectively.EC 50 in group D 1.0 P was significantly decreased compared to that in group P（P〈 0.0167）.【Conclusion】 Dexmedetomidine 0.5 and 1.0 μg/kg can attenuate effectsite concentration of Propofol acquired for different sedation level.