摘要
目的探讨右美托咪定(DEX)用于女性患者全身麻醉诱导期的合理剂量。方法选择美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级、择期行手术治疗的女性患者80例,随机分入4组,每组20例。DEX 0.6组患者于全身麻醉诱导前经静脉输液泵注射DEX 0.6μg/kg,DEX 0.8组患者注射DEX 0.8μg/kg,DEX 1.0组患者注射DEX 1.0μg/kg,空白对照组患者注射0.9%氯化钠溶液10mL。注射DEX 10min后对患者行警觉与镇静评分(改良OAA/S评分),再行丙泊酚靶控输注(TCI)麻醉诱导,效应室靶浓度达到3.0μg/mL时行气管插管。记录各时间点的脑电双频指数(BIS)、收缩压(SBP)、心率(HR)。术后随访患者有无低血压、心动过缓、头痛、口干和术中知晓发生。结果空白对照组在T1时间点的改良OAA/S评分显著高于DEX 0.6组、DEX 0.8组和DEX 1.0组(P值均<0.05),DEX 0.6组显著高于DEX 0.8组和DEX 1.0组(P值均<0.05),DEX 0.8组显著高于DEX 1.0组(P<0.05)。4组在T1时间点的BIS值均显著低于同组T0时间点(P值均<0.01),DEX 0.6组、DEX 0.8组和DEX 1.0组BIS值下降幅度均显著高于空白对照组(P值均<0.05),DEX0.8组和DEX 1.0组均显著高于DEX 0.6组(P值均<0.05)。DEX 0.6组、DEX 0.8组和空白对照组在T3时间点的BIS值均显著高于同组T2时间点(P值分别<0.05、0.01),DEX 0.6组、DEX 0.8组BIS值上升幅度均显著低于空白对照组(P值均<0.05)。4组在T1时间点的SBP均显著低于同组T0时间点(P值均<0.01),DEX 0.6组、DEX 0.8组和DEX 1.0组的SBP下降幅度均显著高于空白对照组(P值均<0.05),DEX 1.0组显著高于DEX 0.8组和DEX 0.6组(P值均<0.05),DEX 0.8组显著高于DEX 0.6组(P<0.05)。DEX 0.6组、DEX 0.8组和空白对照组在T3时间点的SBP均显著高于同组T2时间点(P值均<0.01),DEX 0.8组SBP上升幅度显著低于DEX 0.6组和空白对照组(P值均<0.05)。DEX 0.6组、DEX 0.8组和DEX 1.0组T1时间点的HR均显著低于同组T0时间点(P值均<0.01),DEX 0.8组和DEX 1.0组的HR下降幅度均显著高于DEX 0.6组(P值均<0.05)。DEX 0.6组、DEX 0.8组和空白对照组在T3时间点的HR均显著快于同组T2时间点(P值均<0.01),DEX 0.8组HR上升幅度显著低于DEX 0.6组和空白对照组(P值均<0.05)。DEX1.0组低血压和心动过缓的发生率均显著高于DEX 0.6组、DEX 0.8组和空白对照组(P值均<0.05)。结论女性患者气管插管前单次经静脉输液泵注射DEX 0.8μg/kg可获得较满意的镇静效果,并可有效地减少气管插管时的血流动力学波动,且该剂量不良反应的发生率较低。
Objective To explore the appropriate dose of dexmedetomidine as an adjuvant for induction of general anesthesia. Methods Eighty American Society of Anesthesiologists (ASA) grade I or Ⅱfemale patients undergoing elective surgery were randomized into 4 groups ( n = 20). Dexmedetomidine (0.6, 0.8, 1.0 μg/kg in group I , Ⅱand Ⅲ or normal saline 10 mL (group N) were intravenously given at least 10 min before anesthesia induction. Modified observer's assessment of alertness/sedation (OAA/S) was performed 10 rain after dexmedetomidine (or normal saline) injection. Then propofol was applied by target-controlled infusion (POD. Tracheal intubation was performed when target level was 3.0 μg/mL. Bispectral index (BIS), systolic blood pressure (SBP) and heart rate (HR) were recorded. The incidence of hypotension, bradycardia, headache, dry mouth and intraoperative awareness were also recorded. Results The modified OAA/S scores at T1 were group Ⅲ〈group Ⅱ 〈group Ⅰ 〈group 1V (all P〈0.05). BIS at T1 were significantly decreased in 4 groups as compared with those at To (all P〈0. 01) ; the decreased ranges of BIS in three dexmedetomidine groups were significantly greater than that in group Ⅳ (P〈0.05); the decreased ranges of BIS in group Ⅱ and Ⅲ were significantly greater than that in group Ⅰ (both P〈0. 05). Compared with that at T2, BIS at T3 were significantly increased in group Ⅰ , Ⅱ and Ⅳ (P〈0.05 or P〈0.01); the increased ranges of BIS in group Ⅰ and Ⅱ were significantly less than that in group Ⅳ (both P〈0. 05). Compared with that at T0, SBP at T1 were significantly decreased in 4 groups (all P〈0.01) ; the decrease ranges of SBP showed that group Ⅲ 〉group Ⅱ 〉group Ⅰ 〉 group Ⅳ (all P〈0.05). SBP at T3 were significantly higher than those at T2 in groupⅠ, Ⅱ and Ⅳ (all P〈0.05); the increased range of SBP in group Ⅱ was significantly less than those in group Ⅰ and Ⅳ (both P〈0. 05). HR at T1 were significantly lower than those at To in group Ⅰ , Ⅱ and Ⅲ (all P〈0.01) ; the decreased ranges of HR in group Ⅱ and Ⅲ were significantly greater than that in group Ⅰ (both P〈0. 05). HR at T3 were significantly higher than those at T2 in group Ⅰ , Ⅱ and Ⅳ (all P〈0.01) ; the increased range of HR in group Ⅱ was significantly less than those in group Ⅰ and Ⅳ (both P〈0. 05). The incidence of hypotension and bradycardia in group Ⅲ were significantly higher than those in group Ⅰ , Ⅱ and Ⅳ (all P〈0.05). Conclusion It is concluded that 0.8 μg/kg Dexmedetomidine is the appropriate dose as an adjuvant for induction of anesthesia. It can achieve satisfactory sedation and reduce stress response to tracheal intubation and the incidence of side effects. (Shanghai Med J, 2014, 37: 1012-1016)
出处
《上海医学》
CAS
CSCD
北大核心
2014年第12期1012-1016,共5页
Shanghai Medical Journal
基金
上海市卫生和计划生育委员会青年基金项目(20144Y0209)
关键词
右美托咪定
全身麻醉
血流动力学
不良反应
Dexmedetomidine
General anesthesia
Hemodynamics
Adverse reaction