右美托咪定用于舒芬太尼伴七氟烷全麻在腹腔镜手术中的随机对照研究

Effects of Dexmedetomidine Combined With Sufentanil and Sevoflurane in Patients Undergoing Laparoscopic Surgery Under General Anesthesia: a Randomized Controlled Trial

目的探讨右美托咪定用于舒芬太尼靶控输注伴七氟烷全麻的效果。方法 2017年8月～2018年1月,择期全麻下腹腔镜手术40例(18～68岁,ASAⅠ级或Ⅱ级),随机分为观察组和对照组,每组20例。观察组麻醉诱导前静脉输注右美托咪定0.3μg/kg(10 min输注完成),对照组静脉输注等量生理盐水。麻醉诱导采用靶控输注舒芬太尼、丙泊酚和罗库溴铵静脉注射。麻醉维持采用靶控输注舒芬太尼复合吸入七氟烷,间断静脉注射罗库溴铵维持肌肉松弛。比较2组基础值、右美托咪定或生理盐水输注完成即刻、气管插管后1 min、气腹后10 min、开始关伤口时、气管拔管前即刻和拔管后1 min时的平均动脉压、心率、脑电双频指数(BIS),以及麻醉后苏醒情况和术后24 h内不良反应。结果围术期2组平均动脉压和心率平稳(在基础值上下20%之内),BIS值适宜(术中40～60,麻醉苏醒、镇静至清醒状态70～100)。右美托咪定或生理盐水输注完成即刻,观察组心率[(70.0±9.2)次/min]慢于对照组[(79.6±10.7)次/min](t=-3.015,P=0.005),观察组BIS值(92.3±0.8)低于对照组(96.4±0.9)(t=-15.265,P=0.000)。2组均无肌肉僵直、躁动、呼吸抑制或术中知晓发生,2组术后拔管时间、恶心呕吐及使用镇痛药例数差异无显著性(P>0.05)。结论麻醉诱导前将右美托咪定0.3μg/kg用于舒芬太尼靶控输注伴七氟烷吸入的国人全麻手术安全有效。

Objective To investigate the effects of dexmedetomidine combined with sufentanil administered by targetcontrolled infusion（ TCI） and sevoflurane in general anesthesia. Methods Forty patients with American Society of Anesthesiologists（ ASA） physical status Ⅰ or Ⅱ,aged 18-68 years old,scheduled for elective laparoscopic surgery under general anesthesia from August 2017 to January 2018,were included in this study. The patients were randomly divided into two groups with 20 patients in each group： study group and control group. Dexmedetomidine 0. 3 μg/kg was infused intravenously over 10 min just before induction of anesthesia in the study group,while the equal volume of normal saline was administered instead in the control group. Anesthesia was induced with sufentanil TCI combined with propofol TCI,and intravenous injection of rocuronium. Anesthesia was maintained with sufentanil TCI combined with inhalation of sevoflurane,and intermittent intravenous boluses of rocuronium as needed to maintain muscle relaxation. The mean arterial pressure（ MAP）,heart rate（ HR） and bispectral index（ BIS） at the time points of baseline,just finished infusion of dexmedetomidine or normal saline,1 min after tracheal intubation,10 min after pneumoperitoneum,start of wound suture,just before tracheal extubation and 1 min after tracheal extubation were compared. The recovery profile after anesthesia and adverse effect within 24 h after surgery were also observed. Results All the patients in both groups had smooth MAP and HR,as well as suitable BIS variables during perioperative stage. The HR values were lower in the study group [（ 70. 0 ± 9. 2） beats/min]than that in the control group [（ 79. 6 ± 10. 7） beats/min,t =-3. 015,P = 0. 005] and the BIS levels were lower in the study group（ 92. 3 ± 0. 8） than that in the control group（ 96. 4 ± 0. 9,t =-15. 265,P = 0. 000） at the time point of just finished infusion of dexmedetomidine or normal saline. There was no episode of muscle rigidity,agitation,respiratory depression or intraoperative awareness. There was no significant difference in postoperative extubation time,postoperative nausea and vomiting,as well as the use of analgesics between the two groups（ P〉0. 05）. Conclusion Dexmedetomidine 0. 3 μg/kg administered before induction of anesthesia combined with sufentanil TCI and sevoflurane inhalation can provide safe and efficient management of general anesthesia in Chinese surgical patients.