右美托咪定复合七氟烷全麻对高血压患者行腹腔镜手术术后恢复的影响

Effect of Dexmedetomidine Combined with Sevoflurane for General Anesthesia on Recovery Quality in Hypertensive Patients Undergoing Laparoscopy

目的探讨右美托咪定或瑞芬太尼复合七氟烷全身麻醉对高血压患者行腹腔镜手术术后恢复质量的影响。方法 40例ASAⅠ-Ⅲ级合并高血压腹腔镜手术患者,随机分为两组:右美托咪定组和瑞芬太尼组,两组患者都用咪达唑仑0.06 mg/kg,丙泊酚1.5 mg/kg,芬太尼3μg/kg,顺式阿曲库铵0.2 mg/kg诱导插管,术中七氟烷2%～4%维持,间断加入肌松药顺式阿曲库铵0.1 mg/kg,右美托咪定组以右美托咪定0.5μg/(kg·h)维持,瑞芬太尼组以瑞芬太尼0.1μg/(kg·min)维持,术中麻醉深度维持于40～60,术毕30 min前停右美托咪定,5 min前停七氟烷和瑞芬太尼,观察患者吸气、睁眼、拔管、定向力恢复等恢复时间、术后不同时点生命体征及不良反应。结果右美托咪定组与瑞芬太尼组术中麻醉深度合适,两组无统计学差异;右美托咪定组术毕拔管时间、睁眼时间、定向力恢复时间较长,需要追加镇痛药的患者较少,且能抑制高血压患者拔管期应激反应;右美托咪定组术毕躁动发生率、恶心呕吐不良反应发生率低于瑞芬太尼组,差异有显著性。结论与瑞芬太尼复合七氟烷麻醉相比,右美托咪定复合七氟烷麻醉能降低躁动与其他不良反应发生,抑制拔管期应激反应,提高高血压患者行腹腔镜手术恢复期的质量。

Aim To compare the effects of dexmedetomidine combined with sevoflurane versus remifentanil for general anesthesia on recovery quality in hypertensive patients undergoing laparoscopy. Methods Forty ASAⅠ-Ⅲwith hypertension undergoing laparoscopy patients were randomly divided into two gyoups： dexmedetomidine group and remifentanil group. Anesthesia was induced with midazolam 0. 06 mg /kg,propofol 1. 5 mg /kg and fentanyl 3 μg /kg.Tracheal intubation was facilitated with cis-atracurium 0. 2 mg /kg. Anesthesia was maintained with 2% ～ 4% sevoflurane and intermittent iv boluses of cis-atracurium 0. 1 mg /kg. After induction of anesthesia,dexmedetomidine was infused at0. 5 μg /（kg·h） in dexmedetomidine group and remifentanil at 0. 1 μg /（ kg·min） in remifentanil group. Narcotrend index was maintained between 40 ～ 60. Dexmedetomidine were withdrawn 30 min before and remifentanil and sevoflurane were stopped 5 min before the end of surgery. Time of inspiration,eye opening,extubation and orientation as well as length of post-anaesthesia care unit（PACU） stay were recorded. Follow-up evaluations were performed to assess hemodynamic variables,the need for analgesics,and side effects. Results The time of eye opening,extubation and orientation as well as length of post-anaesthesia care unit stay were not significantly different in dexmedetomidine group than those in remifentanil group. However,SBP,DBP and HR in dexmedetomidine group during extubation and 1 min after extubation were significantly lower than those in Remifentanil group and three patients in dexmedetomidine group required opiods,less than that in remifentanil group. The percentages of patients suffering restlessness,shivering or postoperative nausea and vomiting were lower in dexmedetomidine group than those in remifentanil group. Conclusion The efficacy of dexmedetomidine combined with sevoflurane anesthesia is better than remifentanil combined with sevoflurane anesthesia in hypertensive patients undergoing laproscopy.