右美托咪啶静脉复合麻醉在腹腔镜胆囊切除术的临床观察

Clinical Investigation on Total Intranenous Anesthesia with Dexmedetomidine and Remifentanil for Laparoscopic Cholecystectomy

目的:观察右美托咪啶复合瑞芬太尼行静脉麻醉用于腹腔镜胆囊切除术(LC)的麻醉效果及术中知晓情况。方法:择期行LC患者240例,随机分均为右美托咪啶组(D组)和丙泊酚组(P组)。D组给以右美托咪啶复合瑞芬太尼和顺阿曲库铵麻醉诱导和维持,P组则以丙泊酚复合瑞芬太尼和顺阿曲库铵行麻醉诱导和维持。记录麻醉诱导、插管及腹腔充气的心血管反应;记录术中用药、术后恢复情况以及患者的满意度。并调查术中知晓发生率。结果:D组患者的麻醉诱导和气管插管未见血压明显变化,腹腔充气血压升高(P<0.01),拔管后血压降低(P<0.01);P组患者麻醉诱导后血压降低(P<0.01)。D组麻醉和手术过程心率降低(P<0.01)而P组心率保持不变。P组清醒拔管时间均少于D组(P<0.05)。D组阿托品和乌拉地尔的使用较多(P<0.01),麻黄碱使用较少(P<0.05)。D组术后即时镇痛(P<0.01)、恶心呕吐发生率少于P组(P<0.05)。结论:右美托咪啶复合瑞芬太尼麻醉效果确切、安全,是腹腔镜胆囊切除术麻醉选择方法之一,术中注意右美托咪啶诱导给药速度、加强心率监护和管理,且无术中知晓发生。

Objective To evaluate the efficacy and investigate the incidence of awareness of intravenous an- esthesia with Dexmedetomidine and Remifentanil for laparoseopic cholecysteetomy and to assess whether wake- fulness is suppressed adequately. Methods Two hundred and forty patients scheduled for laparoscopic chole- cysteetomy were randomly allocated into dexmedetomidine group （group D） and propofol group （group P）. Those in Group D received Dexmedetomidine and Remifentanil, while those in group P received Propofol Remifentanil for induction and maintenance of anesthesia. Cardiovascular reaction, auxiliary drug administration and nausea and vomiting were recorded during anesthesia and operation.To investigate the incidence of awareness during general anesthesia. All patients were reviewed for satisfaction after operation. Results MAP remained con- stant during induction of anesthesia, increased after aeroperitoneum （P 〈 0.01） and decreased 5 min （P 〈 0.01） after exubation in group D, while MAP decreased during induction of anesthesia （P 〈 0.01） in group P. HR de- creased during anesthesia in group D （P 〈 0.01） while remained stable in group P. The time to recovery from consciousness, time of exubation in group P were shorter than those in group D （P 〈 0.05）. More patients in group D were administered atropine and urapidil but fewer patients were used ephedrine compared with group P （P 〈 0.01）. Fewer patients in group D needed transient analgesics and fewer patients developed nausea and vom- iting than those in group P（P 〈 0.05） .The rate of patient-rated satisfaction was comparable in two groups （P 〈 0.01）. Condusion Intravenous anesthesia with dexmedetomidine and remifentanil is safe and reliable, which can be a good alternative for anesthesia for laparoscopic cholecysteetomy, and prevents awareness during anaes- thesia.