丙泊酚和右美托咪定单用及联合应用对全身麻醉腹腔镜手术患者麻醉苏醒质量及血流动力学指标的影响

Comparison of effect of using propofol or dexmedetomidine alone with their combined use on hemodynamic parameters and time to awakening in patients after general anesthesia

目的比较丙泊酚和右美托咪定单用及联合应用对患者全身麻醉后血流动力学指标、苏醒时间的影响。方法将2018年6月至2020年6月来安徽医科大学第三附属医院进行全麻手术的患者根据随机数字表法分为3组:丙泊酚组、右美托咪定组以及联合组;记录所有患者苏醒时间、拔管时间;比较各组患者麻醉诱导前(T_(0))、插管前(T_(1))、插管后1 min(T_(2))、切皮前(T_(3))、拔管后3 min(T_(4))时的心率(HR)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)以及麻醉深度指数脑电双频指数(BIS)、脑状态指数(CSI);记录患者的Riker镇静-躁动评分(SAS)以及不良反应发生率。结果右美托咪定组患者拔管[(11.50±2.44)min]、苏醒时间[(24.56±5.21)min]长于丙泊酚组[(9.03±3.12)min、(20.43±3.45)min]以及联合组[(8.91±2.31)min、(19.25±4.10)min](F=9.291,11.024,均P<0.05);SAS评分丙泊酚组(5.83±0.92)分,高于右美托咪定组(4.42±0.52)分和联合组(4.39±0.47)分(F=6.436,P<0.05)。丙泊酚组患者血流动力学(HR、SBP、DBP与MAP指标)受插管拔管影响大于右美托咪定组以及联合组(P<0.05);3组BIS、CSI指数皆处于40~60之间,表明麻醉能顺利进行;联合组不良反应发生率(8.00%)低于丙泊酚组(27.08%)和右美托咪定组(26.92%),差异有统计学意义(χ^(2)=7.954,P<0.05)。结论右美托咪定与丙泊酚联合使用可以稳定血流动力学波动,缩短苏醒时间,降低不良反应发生率。

Objective To compare the effect of propofol or dexmedetomidine alone with that of their combined use on hemodynamic indexes and wake time in patients after general anesthesia.Methods Patients who came to the Third Affiliated Hospital of Anhui Medical University for general anesthesia from June 2018 to June 2020 were divided into three groups of the propofol group,dexmedetomidine group and combination group using the random number table method.Time to awakening and that to extubation were recorded for all patients.The heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),anesthesia depth index(BIS)and cerebral state index(CSI)before anesthesia induction(T_(0)),before intubation(T_(1)),1 minute after intubation(T_(2)),before skin incision(T_(3)),and 3 minutes after extubation(T4)were compared among the three groups.The Riker sedation restlessness score(SAS)and incidence of adverse reactions were also compared among the three groups.Results The extubation time((11.50±2.44)min)and recovery time((24.56±5.21)min)of patients in the dexmedetomidine group were significantly longer than those in the propofol group((9.03±3.12)min,(20.43±3.45)min)and the combination group((8.91±2.31)min,(19.25±4.10)min)(F=9.291,11.024,both P<0.05).The SAS score of the propofol group(5.83±0.92)was significantly higher than that of dexmedetomidine group(4.42±0.52)and combination group(4.39±0.47)(P<0.05).The hemodynamic parameters(HR,SBP,DBP,and MAP)in the propofol group were significantly more affected by intubation and extubation than those in the dexmedetomidine group and the combination group(F=6.436,P<0.05).The BIS and CSI indices of the three groups were all between 40 and 60,indicating that anesthesia could proceed smoothly.The incidence of adverse reactions in the combination group(8.00%)was significantly lower than that in the propofol group(27.08%)and the dexmedetomidine group(26.92%)(χ^(2)=7.954,P<0.05).Conclusion Dexmedetomidine combined with propofol can stabilize hemodynamic fluctuations,reduce wake-up time and decrease the incidence of adverse effects.