不同剂量的右美托咪定在腹腔镜胆囊切除术中的应用

The application of different doses of dexmedetomidine in laparoscopic cholecystectomy

目的:探讨右美托咪定(dexmedetomidine,DEX)在腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中的适宜剂量。方法:80例患者随机分为C组和D1、D2、D3组,分别在麻醉诱导前10 min内泵注0.0μg/kg、0.4μg/kg、0.6μg/kg、0.8μg/kg的DEX。4组患者麻醉诱导方法相同,术中通过七氟烷、芬太尼维持麻醉。记录入室时(T1)、麻醉诱导前(T2)、插管后即刻(T3)、气腹建立时(T4)、气腹建立后3 min(T5)、拔管后即刻(T6)的平均动脉压、心率;记录术中麻醉药用量及术后苏醒情况。比较T1、T3、T4时血浆肾上腺素(E)和去甲肾上腺素(NE)水平。结果:与C组比较,D1、D2、D3组术中血流动力学更为平稳,丙泊酚和芬太尼用量减少(P<0.05),D3组心动过缓发生率较高。与C组比较,D3组在T3和T4时血浆E水平降低(P<0.05),在T4时血浆NE水平降低(P<0.05)。结论:术前泵注0.4μg/kg的DEX可减少LC术中麻醉药用量,稳定术中血流动力学且无明显副作用。

Objective： To investigate the appropriate dose of dexmedetomidine （DEX） infusion in laparoscopic cholecystectomy （LC）. Methods： 80 patients were randomly divided into four groups： group C,group D~ ,group Dz and group D3. DEX 0.0 Ixg/kg, 0.4 ~xg/kg,0.6 Ixg/kg and 0.8 ~xg/kg were given ten minutes before induction respectively. Anaesthesia was induced in the same way among the four groups. Sevoflurane and fentanyl were used to maintain anesthesia. The mean arterial pressure（MAP） and heart rate （HR） were monitored before DEX administration （ T1 ） , before induction （ T2 ） , immediately after tracheal intubation （ T3 ） , immediately after pneumoperitoneum （T4 ） , three minutes after pneumoperitoneum （T5 ） , and at the time of extubation（ T6 ）. The amount of anesthet- ics and the recovery profiles were recorded. Venous samples were collected at T1 ,T3 and T4 for evaluating epinephrine（E） and norepi- nephrine（NE） levels. Results： Compared with group C, groups D1, D2 and D3 had better intraoperative hemodynamics stability with decreased propofol and fentanyl doses （P 〈 0.05 ）. The incidence of bradycardia was higher in group D3. Compared with group C ,the E-level of blood plasma at T3 and T4 were lower in group D3 （P 〈 0.05）. The norepinephrine of blood plasma was reduced at T4 in group D3 （P 〈 0.05） . Conclusion： 0.4 p^g/kg of dexmedetomidine infusion before induction of anesthesia in LC could reduce the dose of anesthetics and promote hemodynamie stability without any side-effect.