不同剂量右美托咪定联合瑞芬太尼应用于腹部手术患者术后的效果观察

The postoperative effects of different doses of dexmedetomidine combined with remifentanil applied on patients undergoing abdominal surgery

目的探讨不同剂量右美托咪定联合瑞芬太尼应用于腹部手术的麻醉效果和安全性。方法选取全麻下腹部手术患者120例,分为生理盐水组、F1、F2、F3组各30例。各组均采用瑞芬太尼进行麻醉诱导和维持,F1、F2、F3组患者在麻醉诱导前分别予以右美托咪定0.5、0.8、1.0μg/kg静脉泵注,生理盐水组输入等量生理盐水。比较各组围术期血流动力学指标,术中麻醉情况,术后疼痛、镇静效果及不良反应。结果F1~3组患者围术期心率(HR)、平均动脉压(MAP)及术后VAS评分较生理盐水组低(P<0.05),且F2、F3组较F1组低(P<0.05);F1~3组患者术后Ramsay评分较生理盐水组高,且F2、F3组较F1组高(P<0.05);4组丙泊酚、瑞芬太尼用量比较:生理盐水组>F1组>F2组>F3组(P<0.05),F3组患者苏醒时间、拔管时间长于生理盐水组和F1、F2组(P<0.05);F3组患者低血压、心动过缓发生率均较生理盐水组高(P<0.05),F1、F2、F3组患者躁动、寒战发生率均较生理盐水组低(P<0.05)。结论右美托咪定联合瑞芬太尼有利于维持腹部手术患者围术期血流动力学稳定,0.8μg/kg是较为安全的临床应用剂量。

Objective To explore the anesthetic effects and safety of different doses of dexmedetomidine combined with remifentanil in abdominal surgery.Methods A total of 120 patients who underwent abdominal surgery with general anesthesia were selected and divided into normal saline group and groups F1,F2 and F3,30 in each group.All the groups were given remifentanil for anesthesia induction and maintenance,and the groups F1,F2 and F3 were given intravenous injection pump of 0.5,0.8 and 1.0μg/kg of dexmedetomidine respectively before anesthesia induction.The normal saline group was given the same amount of normal saline.The perioperative hemodynamic indexes,intraoperative anesthesia,postoperative pain,sedation effects and adverse reactions were compared among the groups.Results The perioperative HR and MAP and postoperative VAS score in the groups F1,F2 and F3 were lower than those in the normal saline group(P<0.05),and the indexes in the groups F2 and F3 were lower than those in the group F1(P<0.05).The postoperative Ramsay score in the groups F1,F2 and F3 was higher than that in the normal saline group,and the score in the groups F2 and F3 was higher than that in the group F1(P<0.05).The doses of propofol and remifentanil in the four groups showed that normal saline group>group F1>group F2>group F3(P<0.05),and the recovery time and extubation time in the group F3 were longer than those in the normal saline group and groups F1 and F2(P<0.05).The incidence rates of hypotension and bradycardia in the group F3 were higher than those in the normal saline group(P<0.05),and the incidence rates of agitation and chills in the groups F1,F2 and F3 were lower than those in the normal saline group(P<0.05).Conclusion Dexmedetomidine combined with remifentanil is beneficial to maintain perioperative hemodynamic stability in patients undergoing abdominal surgery,and 0.8μg/kg is a safe clinical application dose.