右旋美托咪啶对患者镇静效应和血流动力学的影响

Effect of dexmedetomidine on depth of sedation and hemodynamics in patients undergoing general anesthesia

目的 探讨脑电双频指数（BIS）监测下右旋美托咪啶（Dex）对患者的镇静效应及血流动力学的影响.方法 选取潍坊医学院附属益都中心医院自2011年9月至2013年8月择期行全麻手术的胶质瘤患者80例,分为Dex组（45例）和对照组（35例）.Dex组患者术前静脉注射0.4μg/kg Dex,5 min内注射完毕后以每小时0.4 μg/kg维持静脉滴注30 min;对照组患者以同样的方式注射等量生理盐水.2组患者的其他麻醉诱导、麻醉维持用药相同.记录2组患者注射Dex前（T0）、注射后即刻（T1）及静脉滴注后10 min（T2）、20 min（T3）和30 min（T4）的BIS值、心率（HR）、收缩压（SBP）、舒张压（DBP）,并对患者进行警觉/镇静评分（OAA/S）、Ramesay镇静评分.结果 与对照组比较,Dex组患者T1、T2、T3和T4时的BIS和OAA/S评分较低、Ramsay评分较高,差异均有统计学意义（P＜0.05）.与对照组比较,Dex组患者T1、T2、T3、T4时的HR较慢、T1、T2时的SBP较高,差异有统计学意义（P＜0.05）.2组患者T3、T4时的SBP及T1、T2、T3、T4时的DBP比较差异均无统计学意义（P＞0.05）.结论 静脉注射Dex可使清醒患者产生明显的镇静效应,加深麻醉手术患者的麻醉深度,引起HR减慢.

Objective To discuss the effect ofdexmedetomidine （Dex） on depth of sedation and hemodynamics in patients undergoing general anesthesia with monitor of bispectral index.Methods Eighty patients with gliomas,admitted to our hospital from September 2011 to August 2013 and accepted surgery under general anaesthesia,were randomly divided into Dex group and control group （n=45）.Patients from the Dex group received intravenous injection of 0.4 μg/kg before operation;and 5 min after that,Dex at a loading dose of 0.4 μg/kg was given for 30 min;and 0.9% normal saline was given to the control group.The bispectral index （BIS）,heart rate （HR）,systolic blood pressure （SBP）,diastolic blood pressure （DBP）,observer assessment of alertness/sedation （OAA/S） scores and Ramsay sedation scale scores were monitored before Dex infusion （T0） and after loading （T1）,and at 10,20,30 min （T2-T4） after continuous infusion.Results As compared with those in the control group,the BIS and OAA/S scores in the Dex group was significantly decreased,and the Ramsay sedation scale scores were statistically increased at T1,T2,T3 and T4 （P〈0.05）;the HR at T1,T2,T3 and T4 was slower and the SBP at T1 and T2 was higher in the Dex group than those in the control group,with significant differences （P〈0.05）.SBP at T3 and T4 and DBP at T1,T2,T3 and T4 showed no significant difference between the two groups （P〉0.05）.Conclusion Intravenous Dex can make conscious patients has obvious sedative effects,deepen anesthesia depth of anesthesia surgery patients and reduce the dosage of propofol,and can cause HR decreasing.