预注不同负荷剂量右美托咪定在腹腔镜胆囊切除术中的应用

Appllication of different loading doses of dexmedetomidine pre-injection in laparoscopic cholecystectomy

目的比较麻醉诱导前预注不同负荷剂量右美托咪定在腹腔镜胆囊切除术中的应用效果。方法选择2019年12月至2020年12月择期全麻下行腹腔镜胆囊切除术的患者120例,男52例,女68例,年龄18~64岁,BMI 20~35 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法将患者分为四组:生理盐水组(C组)、右美托咪定0.5μg/kg组(L组)、右美托咪定0.75μg/kg组(M组)和右美托咪定1.0μg/kg组(H组),每组30例。C组麻醉诱导前10 min恒速静脉泵注生理盐水0.5 ml/kg,L组、M组和H组麻醉诱导前10 min分别恒速静脉泵注右美托咪定0.5、0.75和1.0μg/kg。所有患者为全凭静脉麻醉,麻醉用药相同。记录输注生理盐水/右美托咪定前即刻(T_(1))、麻醉诱导前即刻(T_(2))、气管插管后即刻(T_(3))、手术切皮即刻(T_(4))、气腹开始即刻(T_(5))、气腹后10 min(T_(6))、缝合完毕即刻(T_(7))、气管拔管后即刻(T_(8))的HR和MAP。记录术中丙泊酚、瑞芬太尼用量、阿托品使用例数、苏醒时间、拔管时间、术后1、4 h咳嗽时VAS疼痛评分。记录苏醒期躁动、术后心动过缓、术后低血压、术后48 h内恶心呕吐等不良反应发生情况。结果与C组比较,L组、M组和H组T_(2)—T_(8)时HR明显减慢(P<0.05),T_(3)—T_(8)时MAP明显降低(P<0.05),术中丙泊酚和瑞芬太尼用量明显减少(P<0.05),术后1、4 h咳嗽时VAS疼痛评分明显降低(P<0.05),苏醒期躁动、术后恶心呕吐发生率明显降低(P<0.05);M组苏醒时间、拔管时间明显缩短(P<0.05);H组阿托品使用率明显升高(P<0.05),苏醒时间、拔管时间明显延长(P<0.05),术后心动过缓和低血压发生率明显升高(P<0.05)。与L组比较,H组T_(2)—T_(6)时HR明显减慢(P<0.05),M组和H组术后1、4 h咳嗽时VAS疼痛评分明显降低(P<0.05)。结论腹腔镜胆囊切除术全麻诱导前预注右美托咪定0.75μg/kg可以有效维持围术期血流动力学稳定,减少麻醉药物用量,缩短苏醒时间,减少术后并发症,有利于患者术后恢复。

Objective To compare the effect of dexmedetomidine pre-injection with different loading doses before anesthesia induction in general anesthesia during laparoscopic cholecystectomy.Methods A total of 120 patients,52 males and 68 females,aged 18-64 years,BMI 20-35 kg/m^(2),ASA physical statusⅠorⅡ,undergoing laparoscopic cholecystectomy under intravenous general anesthesia from December 2019 to December 2020 were enrolled.The patients were divided into four groups using random number table method:normal saline group(group C),dexmedetomidine 0.5μg/kg group(group L),dexmedetomidine 0.75μg/kg group(group M),and dexmedetomidine 1.0μg/kg group(group H),30 patients in each group.Normal saline 0.5 ml/kg was injected intravenously at a constant rate within 10 minutes before anesthesia induction in group C,dexmedetomidine 0.5,0.75 and 1.0μg/kg was injected intravenously at a constant rate within 10 minutes before anesthesia induction in groups L,M and H,respectively.Intravenous anesthesia was used to maintain the anesthetic state.The HR and MAP of patients were recorded immediately before dexmedetomidine/normalsaline infusion(T_(1)),immediately before anesthesia induction(T_(2)),immediately after endotracheal intubation(T_(3)),surgery skin instantly(T_(4)),pneumoperitoneum start instantly(T_(5)),10 minutes after pneumoperitoneum(T_(6)),stitching finished instantly(T_(7)),tracheal extubation instantly(T_(8)).Total intraoperative amounts of propofol and remifentanil,usage of atropine,recovery time,extubation time,postoperative VAS score when coughing were recorded.The occurrence of adverse reactions such as emergence agitation,bradycardia,hypotension,and nausea and vomiting within 48 hours after surgery were also recorded.Results Compared with group C,HR in groups L,M and H decreased significantly at T_(2)-T_(8)(P<0.05),MAP in groups L,M and H decreased significantly at T_(3)-T_(8)(P<0.05),the dosage of propofol and remifentanil during operation was significantly reduced in groups L,M and H(P<0.05),VAS scores when conghing were significantly decreased 1 hour and 4 hours after operation in groups L,M and H(P<0.05),the incidence of emergence agitation,nausea,vomiting after surgery were significantly decreased in groups L,M and H(P<0.05),the recovery time and extubation time in group M were significantly shortened(P<0.05),the usage of atropine in group H was significantly increased(P<0.05),the recovery time and extubation time in group H were significantly prolonged(P<0.05),incidence of bradycardia and hypotension in group H increased significantly(P<0.05).Compared with group L,HR in groups M and H decreased significantly at T_(2)-T_(6)(P<0.05),VAS scores when coughing 1 hour and 4 hours after operation in groups M and H were decreased significantly(P<0.05).Conclusion Pre-injection of dexmedetomidine 0.75μg/kg before induction of general anesthesia in laparoscopic cholecystectomy can effectively stable perioperative hemodynamic fluctuations,reduce the amount of anesthetic drugs,shorten the recovery time,reduce postoperative complications,and benefit patients postoperative recovery.