右美托咪定辅助颈椎手术静脉全麻的临床观察

Clinical observation of dexmedetomidine as an adjuvant to total intravenous anesthesia in cervical operations

目的:观察右美托咪定辅助颈椎手术静脉全麻时丙泊酚用量和对术中血压、心率的影响。方法:选择40例行颈椎手术的颈椎受限患者,随机分成右美托咪定+丙泊酚+瑞芬太尼组(D组,n=20)和生理盐水+丙泊酚+瑞芬太尼组(N组,n=20)。D组于诱导前10 min静脉泵注右美托咪啶1μg/kg,N组静脉泵注相同容量的生理盐水。术中以瑞芬太尼(血浆浓度,4 ng/mL)和丙泊酚(血浆浓度,据术中血压调节)靶控输注维持麻醉。结果:丙泊酚用量D组、N组分别为(1422.75±180.72)mg和(1902.50±151.64)mg,D组明显减少(P<0.01);瑞芬太尼用量D组、N组分别为(2617.60±144.68)μg和(2642.25±63.37)μg,两组无明显差异(P>0.05)。术中最低MAP、切皮时、术中最低及术中最高HR,D组明显较低(P<0.05)。组内术前、切皮时和术中最高指标比较,两组MAP均无明显差异(P>0.05),D组术前HR高于切皮时和最高HR,后两者间无明显差异。N组最高HR大于术前、切皮时HR(P<0.05),后两者间无明显差异(P>0.05)。结论:右美托咪啶辅助颈椎手术静脉全麻显著减少丙泊酚用量,是有效、安全的静脉全麻的辅助用药。

Objective： To investigate the effect of propofol consumption with the adjuvant of dexmedetomidine to intraoperative blood pressure and heart rate in patients undergoing cervical operations with total intravenous anesthesia. Methods： 40 patients accepted cervical operations were randomly allocated in two groups：Dexmedetomidine＋propofol＋remifentanil group （ group D, n= 20 ） , and normal saline＋propofol＋remifentanil group （group N, n=20）. 1.0μg/kg Dexmedetomidine was administered in group D 10 minutes before the induction. Meanwhile the same volume of normal saline was administered in group N. Anesthesia was maintained by a target-controlled infusion （ TCI） of remifentanil （ plasma concentration, 4 ng/mL） and propofol （ plasma concentration, infusion rate regulated by intraoperative blood pressure） . Results：Propofol consumption was significantly less in group D than in group N （1422.75±180.72 vs. 1902.50±151.64;P〈0.01）. There was no significant difference of remifentanil consumption between the two groups （2617.60±144.6 vs. 2642.25±63.37;P〉0.05）. The minimal MAP, incision HR, intraoperative minimal and maximum HR in group D was significantly less （P〈0.05）. Comparing the maximum HR of preoperation, incision and intraoperation in intra-group, there was no significant difference between the two groups in MAPs （ P〉0.05） . And pre-operative HR was higher than incision and maximum HR in group D, and there was no significant difference between the latter two indicators. The maximum HR was higher than pre-operative and incision HR in group N （ P〈0. 05 ） , and there was no significant difference between the latter two indicators（P〉0.05）. Conclusion： Dexmedetomidine as an adjuvant can significantly reduce Propofol consumption in total intravenous anesthesia （ TIVA） of cervical operations, which is an effective and safe adjunct to TIVA.