右美托咪定在腹腔镜胆囊切除术麻醉中的应用价值

The clinical values of dexmedetomidine in general anesthetic for laparoscopic cholecystectomy

目的：研究右美托咪定在全身麻醉下腹腔镜胆囊切除术中的临床应用价值。方法前瞻性收集胆道结石患者100例，将患者按照完全随机数字表原则分为右美托咪定组和对照组。首要观察指标为患者术中血流动力学变化和术后并发症。结果两组患者 t0、t1、t2、t3、t4和 t5时的平均动脉压等差异均无统计学差异（P ＞0．05）。t0时两组心率差异无统计学意义（P ＝0．503），但是右美托咪定组 t1、t2、t3、t4和 t5时的心率显著降低（P ＜0．05）。与对照组相比，右美托咪定组患者手术时间显著缩短[（118．52±15．42）min 比（127．24±19．14）min，t ＝－5．673，P ＝0．021]；术中心动过速发生率显著降低（36％比64％，χ2＝7．840，P ＜0．001）；寒战发生率显著降低（0％比10％，χ2＝5．263，P ＝0．022）。两组患者术中出血量、高血压、低血压、心动过缓、术后引流量、出血、感染和呕吐发生率差异均无统计学意义（均 P ＞0．05）。结论右美托咪定有助于维持全身麻醉下腹腔镜胆囊切除术患者血流动力学平稳，并减少患者术后寒战发生率。

Objective To investigate the clinical values of dexmedetomidine in general anesthetic for laparo-scopic cholecystectomy.Methods One hundred patients admitted to our center with cholelithes were prospectively studied.According to the principle of completely random digital table,all patients were randomly signed to dexmedeto-midine group or control group.The primary outcomes were hemodynamic changes and postoperative complications. Results There was no significant differences at t0,t1,t2,t3,t4 and t5 in mean arterial pressure （P ＆gt;0.05）.There was no significant difference in heart rate at t0 （P =0.503）,however,compared with the control group,patients in the dexmedetomidine group got a significant reduction in t1,t2,t3,t4 and t5 in heart rate（all P 〈0.05）.Compared with the control group,the operation time of the dexmedetomidine group was significantly shorten[（1 18.52 ±15.42）min vs.（127.24 ±19.14）min,t = -5.673,P =0.021 ],the rate of movement of the center of the operation was significantly decreased （36% vs.64%,χ2 =7.840,P 〈0.001）,the incidence rate decreased significantly （0% vs. 10%,χ2 =5.263,P =0.022）.There was no difference between the two groups in intra -operative bleeding volume, hypertension,hypotension,tachycardia,postoperative drainage volume,postoperative bleeding,infection and vomiting （all P ＆gt;0.05 ）.Conclusion Dexmedetomidine contributed to maintaining the hemodynamic stable in general anesthetic for laparoscopic cholecystectomy,and reducing the rate of shivering.