右美托咪定对胃癌根治术中瑞芬太尼复合丙泊酚全麻药量及麻醉效果的影响

Evaluation of dexmedetomidin in general anesthesia undergoing Gastrectomy with remifentanil and propofol in dosage and effect

目的观察胃癌根治术中右美托咪定辅助全身麻醉对患者围术期血流动力学、麻醉药用量以及术后镇静镇痛的影响。方法择期全麻行胃癌根治术患者40例，随机均分为右美托咪定（D）组和对照（C）组，D组麻醉诱导前15min静脉泵注右美托咪定0．6μg/kg，维持为0．4μg/（kg·h），直至术毕前40min，C组则给予等量的生理盐水。观察注药前（T1）、麻醉诱导前（T2）、气管插管前即刻（T3）、插管后1min（T4）、切皮时（T5）、探查时（T6）、拔管后即刻（T7）的脑双频指数（BIS）、平均动脉压（MAP）、心率（HR），记录丙泊酚和瑞芬太尼的用量，术后4h内的镇静评分Ramsay和视觉模拟评分VAS情况。结果T2时D组BIS值明显低于T，和C组（P〈0．01）；与C组比较，T2、T4-T7时D组MAP明显降低，HR明显减慢（P〈0．05，P〈0．01）；D组丙泊酚和瑞芬太尼的用量明显低于C组（P〈0．05）；D组术后1h和4h的Ramsay评分明显高于C组、VAS评分明显低C组（P〈0．05）。结论右美托咪定辅助全身麻醉可产生明显的镇静，镇痛效应，减少麻醉药的用量，降低了患者术后的不适感。

Objective To investigate the effect of hemodynamics, the amount of anesthetic, sedation and analgesia perioperative administered dexmedetomidine in gastrectomy in general anesthesia. Methods Forty patients （ASA Ⅰ - Ⅱ ） scheduled for elective gastrectomy under general anesthesia were enrolled in this study. All patients were randomly divided into two groups： dexmedetomidine group （group D） and control group （group C）. In group D, 0.6 μg/kg of the loading dose dexmedetomidine was administered intravenously by micro-pump for within 15 minutes before induction of anesthesia, then 0.4 μg/（ kg · h） was maintained until the 40th min end of surgery. While in group C, the same volume of normal saline was given by the same way. The parameters of BIS, MAP and HR were recored before dexmedetomidine or normal saline infused intravenously （ T1 ）, before the induction of anesthesia （T2）, immediately after intubation （T3 ）,1 min after intubation （T4 ）, immediately after skin incision （T5 ）, immediately after operation exploration （T6） , immediately after extubation （T7）. The parameters were recorded such as the amount of propofol and remifentanil, Ramsay and VAS score within four hours after operation. Results Compared to those at T1 and group C, BIS scale of group D at T2 showed significantly decrease （P 〈 0. 01 ）. MAP, HR in group C had a significant increase than those in the group D at T2 ,T4 - T7 （ P 〈 0.05 or P 〈 0.01 ）. Propofol and remifentanil consumption in group D were less than those in group C （P 〈 0. 05 ）. 1 h and 4 h after operation, the Ramsay score in group D was significantly higher than that in group C, the VAS score in group D was significantly lower than that in group C （P 〈 0. 05 ）. Conclusion The application of dexmedetomidine in general anesthesia can produce significant sedation, improve the effect of analgesia, reduce the amount of anesthetic and postoperative discomfort.