右美托咪定辅助全身麻醉对腹部手术患者血流动力学及镇痛效果的影响

Analgesia Effect and Hemodynamics of Dexmedetomidine Assisted General Anesthesia of Laparotomy

目的探讨右美托咪定辅助全身麻醉对腹部手术患者血流动力学及镇痛效果的影响。方法选择2012年1月至2015年1月在常熟市第二人民医院行腹部手术的88例患者作为研究对象,根据随机数字法分为右美托咪定组(44例)和丙泊酚组(44例)。右美托咪定组患者麻醉诱导前15 min静脉泵输注右美托咪定0.6μg/kg,继以0.2μg/(kg·h)维持;丙泊酚组采用丙泊酚(1 mg/kg)进行麻醉诱导,诱导后以100μg/(kg·min)维持麻醉。记录麻醉前(T_0)、麻醉诱导后(T_1)、气管插管后即刻(T_2)、切皮后(T_3)、打开腹腔时(T_4)、冲洗腹腔(T_5)、关腹时(T_6)、拔管后即刻(T_7)、拔管后5 min(T_8)时刻的平均动脉压(MAP)、心率、中心静脉压(CVP)、心排血量、心指数和脑电双频谱指数(BIS)及术后1 h和4 h的镇静效果评分(Ramsay)及视觉模拟评分(VAS)的差异,观察两组患者的苏醒情况,包括苏醒期呼吸恢复时间、呼之睁眼时间、拔管时间以及不良反应的发生情况。结果两组患者MAP、心率、CVP、心排血量、心指数和BIS在组间、时点间以及组间·时点间交互作用比较,差异均有统计学意义(P<0.05),且右美托咪定组患者的MAP、心率、CVP、心排血量、心指数和BIS等的值波动较小,手术结束后的值更接近麻醉前。右美托咪定组患者术后1 h、4 h的VAS小于丙泊酚组[(1.2±0.3)分比(2.3±0.6)分、(1.4±0.3)分比(2.6±0.7)分],Ramsay评分高于丙泊酚组[(3.2±0.5)分比(1.8±0.4)分、(2.5±0.5)分比(1.9±0.4)分](P<0.05)。右美托咪定组患者呼吸恢复时间、呼之睁眼时间、拔管时间均短于丙泊酚组[(3.6±0.4)min比(5.8±0.6)min、(4.1±0.5)min比(7.7±0.8)min、(5.0±0.8)min比(9.1±0.9)min](P<0.05)。右美托咪啶组患者总不良反应发生率低于丙泊酚组[22.73%(10/44)比68.18%(30/44)](P<0.05)。结论开腹手术应用右美托咪定辅助麻醉可有效稳定患者的血流动力学,不良反应的发生率低,提高了临床麻醉效果与手术治疗效果。

Objective To study the analgesia effect and hemodynamies of dexmedetomidine assisted general anesthesia of laparotomy. Methods A total of 88 patients with abdominal operation in Changshu Second People＇s Hospital from Jan. 2012 to Jan. 2015 were included in the study,and divided into a dexmedetomidine group and a propofol group according to the random number method,44 eases each. 15 min before anesthesia induction, dexmedetomidine group was given dexme-detomidine 0. 6 p.g/kg by intravenous infusion, followed by 0. 2 μg/（ kg·h） for maintenance, while the propofol group was given 1 mg/kg propofol for anesthesia induction,followed by 100μg/（ kg·min） for maintenance. The mean arterial pres-sure （ MAP）, heart rate （ HR ）, central venous pressure （ CVP ）, cardiac output （ CO ）, cardiac index （ CI ） and bispeetrial index （BIS） at preanesthesia（ T0）, after anesthesia induction（ T1 ）, immediately after trachea eannula（ T2 ） , skin incision （ T3 ）, opening abdominal cavity （ T4 ）, peritoneal lavage （ T5 ） , closing abdominal cavity （ T6 ）, immediately after extubation （ T7 ） ,5 min after extubation （ Ts ） of the two groups were recorded, and the Ramsay and visual analogue scale （ VAS ） at postoperative 1 h and 4 h were compared, the palinesthesia situation, including respiration recovery time, eye opening time upon calling, extubation time and adverse reactions of the two groups were observed. Results The MAP, heart rate, CVP,cardiac output, heart index between groups, different time points and different groups·time points had statistically significant differences （ P 〈 0. 05 ）, and the MAP, heart rate, CVP, cardiac output, heart index and BIS of the dexmedetomidine group were less fluctuated,which were closer to preanesthesia level at the end of the surgery. VAS of the dexmedetomidine group at 1 h,4 h after operation were less than the propofol group [ （ 1.2 ± 0. 3 ） score vs （2.3 ± 0. 6） score, （ 1.4 ± 0. 3 ） score vs （2.6 ± 0. 7） score ], Ramsay scores of the dexmedetomidine group were higher than the propofol group [ （3.2 ± 0. 5） score vs （ 1.8 ± 0. 4） score, （2.5 ± 0. 5 ） score vs （ 1.9 ± 0. 4） score ], the differences had statistical significance （ P 〈 0.05 ）. The respiratory recovery time, eye opening time upon calling and extubation time of the dexmedetomidine group were less than that of the propofol group[（3.6±0. 4） min vs （5.8 ±0. 6） min, （4. 1 ±0. 5） min vs （7.7 ±0. 8） min, （5.0 ±0. 8） min vs （9. 1 ±0. 9） mini （P 〈0. 05）. The total incidence of adverse reactions of the dexmedetomidine group was lower than the propofol group [ 22.73 % （10/44） vs 68. 18% （30/44） ] （P 〈 O. 05 ）. Conclusion Dexmedetomidine assisted general anesthesia for laparotomy can effectively stablize the hemodynamics and has low incidence of adverse reactions, therefore improves the effect of the clinical anesthesia and surgery.