BIS反馈闭环路靶控输注右美托咪定可减少丙泊酚用量

Effects of dexmedetomidine on propofol dosage in target-controlled infusion and hemodynamics during laparoscopic surgery under general anesthesia

目的比较在静脉麻醉中脑电双频指数(BIS)反馈闭环靶控输注(CL-TCI)调控下,右美托咪定(Dex)对丙泊酚用量及对血流动力学的影响。方法需要60例全麻患者参考随机数字表法随机分为D组(n=30)和C组(n=30),D组患者在术前及术中均泵注Dex直至手术结束;C组患者按照同样的方案泵注等量的生理盐水。检测负荷剂量前(T0),负荷剂量后(T1),插管即刻(T2),切皮(T3),手术开始后30 min(T4),缝皮(T5),拔管即刻(T6)的收缩压(SBP)、舒张压(DBP)、心率(HR);BIS值的变化;诱导期及维持期间的丙泊酚的用量。术中及术后出现的血流动力学不良事件。结果在BIS反馈闭环靶控输注调控下,Dex可有效减少麻醉诱导时间,诱导期及维持期丙泊酚的用量,差异具有统计学意义(P<0.05)。在拔管即刻,D组的HR,SBP及DBP均较C组减低,差异具有统计学意义(P<0.05)。负荷剂量前后D组与C组的BIS值及血流动力学不良反应的发生率差异均无统计学意义(P>0.05)。结论 BIS反馈闭环调控下定量证实Dex可减少丙泊酚的用量,同时可减少血流动力学不良反应的发生,不增加麻醉过深的发生率,是较为理想的麻醉辅助药物及镇静药物。

Objective To assess the effects of dexmedetomidine（Dex） on propofol dosage in target-controlled infusion（TCI） and hemodynamics in patients undergoing laparoscopic surgery under general anesthesia. Methods Sixty patients undergoing laparoscopic surgery under general anesthesia were randomly divided into control group（n=30） and the Dex group（n=30）.The patients in Dex group received a loading dose of Dex（1 μg/kg, infused within 10 min） before the surgery followed by continuous infusion at the rate of 0.3 μg · kg-1· h-1till the end of the surgery, and the control patients received saline infusion in the same manner. Heart rate, blood pressure, bispectral index（BIS）, and propofol dose in TCI were recorded during induction and maintenance of anesthesia. The incidence of hypotension and bradycardia were observed during and after the surgery.Results No difference was found in the incidence of hypotension and bradycardia between the control group and Dex group（P〉0.05）, but heart rate and blood pressure were lower in Dex group during extubation（P〈0.05）. The dose of propofol in TCI was significantly less in Dex group than in the control group（P〈0.05）. Conclusion Dex can reduce hemodynamic abnormalities caused by extubation and decrease the dosage of propofol in TCI, and may serve as an ideal adjuvant drug for general anesthesia.