小剂量右美托咪定对妇科腹腔镜手术麻醉的丙泊酚用量影响

Effects of low-dose dexmedetomidine on the amount of propofol used in gynecologic laparoscopic surgery

目的探讨小剂量右美托咪定用于妇科腹腔镜手术麻醉对丙泊酚用量和苏醒质量的影响。方法选择我院择期全麻行妇科腹腔镜下全子宫切除手术患者80例,ASAⅠ~Ⅱ级,随机分为观察组和对照组,每组40例,观察组患者于麻醉诱导前微量泵输注右美托咪定0.6μg/kg(用生理盐水稀释至20mL),设定时间10min,右美托咪定输注完毕后5min开始全麻诱导,丙泊酚采用靶控输注(TCI),初始效应室靶浓度为1.0μg/mL,每次递增0.2μg/mL,直至BIS保持在45~50之间,静注顺苯阿曲库铵0.2mg/kg,瑞芬太尼(血浆靶浓度4~6ng/mL),行气管插管机械控制呼吸,术中靶控输注丙泊酚(1.0~3.0μg/mL)使BIS监测值保持在50~55之间直至手术结束前10min,术中根据手术刺激强度调整瑞芬太尼的靶浓度在2~4ng/mL之间,缝皮时停用。对照组患者于麻醉诱导前微量泵输注生理盐水20mL,10min内输注完毕,5min开始全麻诱导,其余诱导和维持用药同实验组。记录两组丙泊酚麻醉诱导时的效应室靶浓度和用量以及术毕时的效应室靶浓度和丙泊酚总用量,记录两组患者呼吸恢复时间、苏醒时间、拔管时间、及拔管时患者出现呛咳、躁动等全麻苏醒期不良反应的情况;询问并记录患者有无术中知晓情况。结果观察组和对照组患者麻醉诱导时和术毕时丙泊酚的效应室靶浓度分别是(2.62±0.38)μg/mL和(1.38±0.24)μg/mL(3.81±0.13)μg/mL、和(2.57±0.29)μg/mL,差异均有统计学意义(P<0.05);观察组和对照组患者麻醉诱导时的丙泊酚用量和术毕总用量分别是[(82.4±16.3)mg和(112.6±24.8)mg、(498.5±105.2)mg和(610.6±135.4)mg],差异均有统计学意义(P<0.05);观察组和对照组患者的呼吸恢复时间、拔管时间、苏醒时间分别为[(2.8±0.6)和(2.9±0.7)、(3.8±0.8)和(4.0±0.6)、(5.8±0.7)和(5.9±0.7)],两组相比较差异无统计学意义(P>0.05);观察组和对照组患者的呛咳、躁动发生率分别是[4例(10%)和15例(37.5%)],差异均有统计学意义(P<0.05);两组患者均无出现严重不良反应和术中知晓情况。结论小剂量右美托咪定用于妇科腹腔镜手术麻醉,能明显减少麻醉诱导及麻醉维持的丙泊酚用量,麻醉复苏质量好且患者舒适,是腹腔镜手术麻醉理想辅助用药。

Objective To explore the effects of low-dose dexmedetomidine on the amount of propofol and recovery quality used in gynecologic laparoscopic surgery. Methods 80 cases of total laparoscopic hysterectomy in our hospital under selective general anesthesia （ASA Ⅰ - Ⅱ ） were selected and randomly divided into observation group and control group with 40 cases in each. Patients in observation group were treated with micro pump infusion of dexmedetomidine at 0.6g/kg （diluted to 20ml with saline） before anesthesia induction, Setting time lOmin, after dexmedetomidine infusion, 5min with general anesthesia induction, target controlled infusion （TCI） was used for propofol, and the initial target chamber concentration was 1 g/ml, increments 0.2g/mL per time until BIS remains between 45-50, the intravenous injection of CIS atracurium 0.2mg/kg benzene, remifentanil （target plasma concentration of 4-6ng/mL）, endotracheal intubation; mechanical control of breathing, intraoperative target infusion of propofol （1 to 3g/mL） kept the BIS monitoring between 50 and 55 until the end of surgery, lOmin, the target concentration of remifentanil was adjusted between 2 and 4ng/mL according to the intensity of operation, and the suture was stopped. For patients in control group, before anesthesia induction, micro pump infusion of physiological saline 20mL, 10min infusion finished, 5min began general anesthesia induction, the rest of the induction and maintenance drugs were the same as the experimental group. The target chamber target concentration and dosage of propofol induced anesthesia, the target chamber target concentration at the end of surgery and the total amount of propofol of the two groups was recorded. The respiratory recovery time, recovery time, extubation time, and the emergence of cough, restlessness and other adverse reactions during the general anesthesia recovery period of the two groups were recorded. The patient＇s intraoperative awareness were asked and recorded. Results The target concentration of propofol effect site in the observation group and the control group of patients during induction of anesthesia and postoperative were （2.62± 0.38） μg/mL and （1.38 ±0.24）μg/mL 0.81 ± 0.13）μg/mL and （257± 0.29）μg/mL respectively, the differences were statistically significant（P 〈 0.05）. The induction dose of propofol and the total amount of postoperative anesthesia in the observation group and the control group were [（82.4 ± 16.3）mg and （112.6 ± 24.8） mg, （498.5 ± 105.2） mg and （610.6 ± 135.4）mg] respectively, the differences were statistically significant （P 〈 0.05）. The respiratory recovery time, extnbation time and recovery time in the observation group and the control group were [（2.8 ± 0.6） and （2.9 ± 0.7）, （3.8 ± 0.8） and （4.0 ± 0.6）, （5.8 ± 0.7） and （5.9 ± 0.7）], the difference between the two groups was not statistically significant （P〉 0.05）. The incidence of cough and restlessness in the observation group and the control group were [4 cases （10%） and 15 cases （37.5%）], respectively, and the differences were statistically significant（P 〈 0.05）. There were no severe adverse reactions and intraoperative awareness in the two groups. Conclusion Low dose dexmedetomidine for anesthesia in gynecologic laparoscopic surgery can obviously reduce the amount of propofol used in anesthesia induction and anesthesia maintenance. The quality of anesthesia recovery is good and the patient is comfortable. It is an ideal assistant for laparoseopic operation anesthesia.