右美托咪定复合依托咪酯全麻诱导的临床研究

Clinical research on general anesthesia induced by dexmedetomidine combined with etomidate

目的探讨不同剂量右美托咪定（dexmedetomidine，DEX）复合依托咪酯行全身麻醉（全麻）诱导的麻醉效果。方法选取120例ASA分级Ⅰ～Ⅱ级择期全麻手术患者，随机分为4组（n=30）：对照组（C组）、1．0μg／kgDEX组（D1组）、0．75μg/kg DEX组（D2组）、0．5μg／kgDEX组（D3组）。监测并记录DEX或生理盐水匀速静脉输注（注射）前（T0）、注射后（T1）、注射完成后5min（T2）、气管插管（插管）前（T3）、插管完成时（T4）、插管完成后2min（T5）、3min（T6）各时间点的平均动脉压（MBP）、心率（HR）、脉搏氧饱和度（SpO2）、脑电双频指数（BIS）值、镇静评分（OAA／S）等。结果c组患者气管插管前后HR、MAP、BIS上升显著，差异有统计学意义（P〈0．05）。与c组比较，在T1、T2时刻，D1-2组HR、BIS显著下降，差异有统计学意义（P〈0．05）；T4-6时刻，D1-3组HR、MAP、BIS波动较小，差异有统计学意义（P〈0．05）；D1-2组依托咪酯用量显著减少，差异有统计学意义（P〈0．05）。D1-3组麻醉苏醒无延迟，与C组比较差异无统计学意义（P〉0．05）。结论DEX复合依托咪酯行全麻诱导对维持患者血流动力学稳定有较好效果，且不影响全麻苏醒时间。

Objective To evaluate the general anesthesia induced by different doses of dexmedetomidine （DEX） combined with etomidate. Methods A total of 120 ASA Ⅰ～Ⅱ patients were enrolled in the current study who underwent surgery under general anesthesia condition. They were randomly divided into four groups （n = 30） ： a control group （Group C）, a 1.0 μg/kg Dex group （Group Dl ）, a 0.75 μg/kg Dex group （Group D2） and a 0.5 μg/kg Dex group （ Group D3 ）. The mean blood pressure （MBP） , heart rate （HR） , SPO2, bispectral index （BIS） , and Observer＇s assessment of alertness/sedation （OAA/S） scores were recorded before injection of Dex （TO ） , immediately after injection of DEX （ W1 ）, 5 minutes after injection of Dex （ T2 ）, before intubation （ T3 ）, immediately after intubation （ T4 ）, 2 and 3 minutes after the intubation （ T5 and T6 ）. Results After intubation, patients in Group C produced remarkable increa- ses in HR, MAP, and BIS in comparison with those before intubation （ P 〈 0.05 ）. Compared with Group C, HR and BIS were decreased markedly in Groups D1 and D2 at T1 and T2 （ P 〈 0.05 ）. Groups D1 , D2, and D3 showed less changes in HR, MAP and BIS from W4 to T6 （P 〈 0. 05 ）. The doses of etomidate used in Groups D1 and D2 were significantly reduced （P 〈 0.05 ）. The recovery time of patients in Groups D1 , D2 and D3 were not extended, which were not statistical different from that of Group C （P 〉 0.05 ）. Conclusion Dex combined with etomidate can stabilize patients＇ hemodynamic parameters under general anesthesia condition, and does not extend recovery time.