右美托咪啶对依托咪酯靶控输注效应室浓度及血流动力学的影响

Effect of dexmedetomidine on the hemodynamics and effect-site concentration of etomidate given by target-controlled infusion

目的:以脑电双频指数作为麻醉镇静深度指标,评价不同剂量右美托咪啶对依托咪酯靶控输注效应室浓度及血流动力学的影响。方法:择期全麻下行甲状腺手术患者60例,ASAⅠ或Ⅱ级,随机分为3组:D1组(右美托咪啶1μg·kg-1)、D2组(右美托咪啶0.5μg·kg-1)、C组(生理盐水)(n=20)。经麻醉诱导、麻醉维持后,记录麻醉诱导前(T0)、静脉输注右美托咪啶或生理盐水后(T1)、气管插管前(T2)等8个时间点患者的脑电双频指数(BIS)、血流动力学参数,依托咪酯的效应室浓度,记录依托咪酯和瑞芬太尼用量、苏醒时间、拔管时间、定向力回复时间和不良反应的发生情况。结果:3组依托咪酯平均效应室浓度(Ce)和用量有显著差异。3组苏醒时间和拔管时间无显著差异。结论:在依托咪酯全凭静脉麻醉靶控输注中,右美托咪啶能显著减少依托咪酯的靶控输注效应室浓度和用量及瑞芬太尼用量,1μg·kg-1负荷量和0.4μg·kg-1·h-1维持量能有效抑制插管拔管反射,更好的维持血流动力学的稳定。

Objective：To investigate the effect of dexmedetomidine at various doses on the hemodynamics and effect-site concentration of etomidate given by target-controlled infusion（TCI） with bispectral index as the index of anesthesia depth. Methods： Sixty ASA I or II patients undergoing thyroidectomy were randomly allocated to three groups,and treated with dexmedetomidine 1 μg·kg^- 1（D1） and 0. 5 μg·kg^- 1（D2）,or saline（control）. After induction and maintenance of anesthesia,patients＇ BIS,doses of etomidate and remifentanil,recovery time and adverse reactions and other data were recorded at baseline（T0）,after the loading of study drugs（T1）,before intubation（T2） and another five time points. Results： There were significant differences in mean effect-site concentrations and doses of etomidate among three groups（ P〈0. 05）,but no significant difference in the eye opening time and extubation time. Conclusion： Dexmedetomidine significantly reduces the effect-site concentration and dose of etomidate given by TCI and the dose of remifentanil. The loading dose of 1 μg·kg- 1and maintaining dose of 0. 4 μg·kg- 1·h- 1of dexmedetomidine can effectively depress the intubation and extubation reactions and provide stable hemodynamics.