不同剂量右美托咪定对肥胖患者腹腔镜胆囊切除术中血流动力学及术后恢复的影响

Effects of Different Doses of Dexmedetomidine on Hemodynamics and Postoperative Recovery in Obese Patients Undergoing Laparoscopic Cholecystectom

目的:探讨不同剂量右美托咪定对肥胖患者腹腔镜下胆囊切除术血流动力学和术后恢复的影响。方法:选择择期行腹腔镜下胆囊切除术且体质量指数(BMI)≥30 kg/m2的患者45例,按照随机数字表法随机分为3组:低剂量右美托咪定组(Dex1组)、高剂量右美托咪定组(Dex2组)、对照组(Con组),每组15例。Dex1组于手术开始时泵注右美托咪定0.4μg·kg/h,Dex2组于手术开始时泵注右美托咪定1μg·kg/h,均于手术结束前30 min停止泵注;Con组同时泵注等量的生理盐水。3组患者采用相同的麻醉诱导及维持方案。记录患者各时点的心率(HR),平均动脉压(MBP),拔管时间,拔管时镇静躁动评分(SAS),术后6 h、12 h、24 h视觉模拟疼痛评分(VSA),恶心呕吐例数,同时抽取各时间点动脉血气进行分析比较。结果:C组苏醒期HR均较基础值高,且均高于Dex1、Dex2组(P<0.05);C组在拔管前及拔管时平均心率均高于Dex1、Dex2组(P<0.05);Dex1、Dex2组拔管时SAS,苏醒期躁动评分,术后6 h、12 h、24 h视觉模拟疼痛评分(VSA),恶心呕吐例数均低于C组(P<0.05);Dex2拔管时间与Dex1、C组比较明显延迟(P<0.05),Dex1组拔管时间与C组比较无差异(P>0.05);3组间各时间点血气分析结果无统计学差异(P>0.05)。结论:肥胖患者术中泵注盐酸右美托咪定的适宜剂量为0.4μg·kg/h,不仅不会延长术毕苏醒拔管时间,还能显著提高苏醒期质量。

Objective： To investigate the effects of different doses of dexmedetomidine on hemodynamics and post- operative recovery in obese patients undergoing laparoscopic cholecystectomy. Methods ： Fourty-five patients who underwent laparoscopic cholecystectomy with body mass index （BMI） more than 30 kg/m^2 were randomly divided into 3 groups according to the random digital table method： low dose group （group Dex1 ）, high dose group （Dex2 group） and control group （group Con）, 15 cases in each group. In group Dex1, dexmedetomidine was injected at 0.4 μg· kg/h at the begin- ning of the operation, while Group Dex2 was injected with 1 μg·kg/h. The injection was stopped before the end of the operation, and pateint in group C were injected the same amount of normal saline. The 3 groups received the same anesthesia induction and maintenance. The heart rate （HR）, the average arterial pressure （MBP）, the extubation time, the sedation restlessness score （SAS）, the postoperative 6 h, 12 h, 24 h visual analogue score （VSA）, the number of nausea and vomiting, and the arterial blood gas of each time were compared. Results： The HR in the group C was higher than that in the basic value, and higher than that of the Dex1 and Dex2 group （P〈0.05）, and the average heart rate of the C group before extubation and extubation was higher than that of the Dex1 and Dex2 group （P〈0.05） ; in Dex2 extubation time was significantly delayed compared with group Dex1 and group C （P〈0.05）. There was no difference in extubation time between group Dex1 and C group （P〉0.05）, and there was no statistical difference between the 3 groups at each time point（P〉0.05）. Conclusion：The suitable dose of dexmedetomidine in the operation of obese patients is 0.4 μg· kg/h. It can not only prolong the time of recovery and extubation, but also significantly improve the quality of the awakening period.