CAJ | 학술논문

目的探讨预先注射小剂量右美托咪啶( dexmedetomidine,Dex)对腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)患者全麻效果的影响.方法择期行LC患者50例,ASA Ⅰ ～Ⅱ级,年龄21岁～57岁,体重42.5 kg～80 kg,按随机数字表法分为生理盐水组(C组)和Dex组(D组)两组.C组在麻醉诱导前10 min内静脉注射10 ml生理盐水,D组以同样的方法静脉注射Dex 0.6 μg/kg,然后开始麻醉诱导.分别记录两组患者给药前(T0)、给药后5 min(T1)、麻醉诱导前(T2)、注射丙泊酚后1(T3)、2 min(T4)、插管即刻(T5)、插管后1(T6)、3 min(T7)、手术开始即刻(T8,即插管后5 min)的平均动脉压(MAP)、心率(HR)；记录麻醉时间、手术时间、麻醉结束至拔管时间、术毕患者清醒时间及拔管时患者有无呛咳反射；记录各患者丙泊酚和舒芬太尼的用量；记录各组患者使用阿托品、麻黄素、乌拉地尔及艾司洛尔的次数.结果与C组比较,D组拔管呛咳减少(5vs 14,P＜0.05)；丙泊酚和舒芬太尼用量减少[(385±120) mg vs (493±158) mg,P＜0.05;(33±7) μg vs (38±6) μg,P＜0.01]；阿托品使用率增加(6vs2,P＜0.05),乌拉地尔和艾司洛尔使用率减少(4 vs 12和4vs 11,P＜0.05).C组T3～8各时间点MAP与T0时比较均下降(P＜0.05)；D组T1时MAP升高(P＜0.05)；C组T3～8各时间点MAP较D组有所下降(P＜0.05).C组T4、T5时HR下降(P＜0.05)；D组T1～8各时间点HR较T0时均下降(P＜0.05)；D组T1～3和T6～8各时间点HR较C组下降(P＜0.05).结论腹腔镜胆囊切除术全麻诱导前预先静脉注射0.6μg/kg Dex,可提高全麻质量.
목적 탐토예선주사소제량우미탁미정( dexmedetomidine,Dex)대복강경담낭절제술(laparoscopic cholecystectomy,LC)환자전마효과적영향.방법 택기행LC환자50례,ASA Ⅰ ～Ⅱ급,년령21세～57세,체중42.5 kg～80 kg,안수궤수자표법분위생리염수조(C조)화Dex조(D조)량조.C조재마취유도전10 min내정맥주사10 ml생리염수,D조이동양적방법정맥주사Dex 0.6 μg/kg,연후개시마취유도.분별기록량조환자급약전(T0)、급약후5 min(T1)、마취유도전(T2)、주사병박분후1(T3)、2 min(T4)、삽관즉각(T5)、삽관후1(T6)、3 min(T7)、수술개시즉각(T8,즉삽관후5 min)적평균동맥압(MAP)、심솔(HR)；기록마취시간、수술시간、마취결속지발관시간、술필환자청성시간급발관시환자유무창해반사；기록각환자병박분화서분태니적용량；기록각조환자사용아탁품、마황소、오랍지이급애사락이적차수.결과 여C조비교,D조발관창해감소(5vs 14,P＜0.05)；병박분화서분태니용량감소[(385±120) mg vs (493±158) mg,P＜0.05;(33±7) μg vs (38±6) μg,P＜0.01]；아탁품사용솔증가(6vs2,P＜0.05),오랍지이화애사락이사용솔감소(4 vs 12화4vs 11,P＜0.05).C조T3～8각시간점MAP여T0시비교균하강(P＜0.05)；D조T1시MAP승고(P＜0.05)；C조T3～8각시간점MAP교D조유소하강(P＜0.05).C조T4、T5시HR하강(P＜0.05)；D조T1～8각시간점HR교T0시균하강(P＜0.05)；D조T1～3화T6～8각시간점HR교C조하강(P＜0.05).결론 복강경담낭절제술전마유도전예선정맥주사0.6μg/kg Dex,가제고전마질량.
Objective To observe the effect of single dose dexmedetomine (Dex) on general anesthesia in laparoscpic cholecystectomy.Methods Fifty ASA Ⅰ -Ⅱ patients of both sexes,aged 21 y-57 y,weighing 42.5 kg-80 kg undergoing elective laparoscopic cholecystectomy (LC),were randomly divided into 2 groups (n=25):dexmedetomidine (Dex) group (group D) and control group (group C).Group C received normal saline 10 ml given within 10 min.Group D received equal volume of Dex 0.6 μg/ kg intravenously as group C.MAP and HR were recorded at the time points of pre-administration of Dex (T0),5 min after administration(T1),before anesthesia induction(T2),1 min and 2 min after injecting propofol respectively(T3-4),immediately after intubation (T5),1,3 min and 5 min after intubation (T6～8).The following variables were also recorded:duration of anesthesia and operation,extubation time,regain consciousness time,coughing when extubating,consumption of propofol and sufentanil,and frequency of using vasoactive drugs.Results The occurrence of coughing when extubating was decreased (5 vs 14,P＜0.05),and the requirements of propofol,sufentanil,urapidil and esmolol were decreased [(385±120) mg vs (493±158) mg,P＜0.05; (33±7)μg vs (38±6) μg,P＜0.01; 4 vs 12,P＜0.05; 4 vs 11,P＜0.05)],but the requirement of atropine was increased in group D than in group C(6 vs 2,P＜0.05).Compared with To or every time points of group D,MAP was significantly decreased at T3-8 in group C (P＜0.05).MAP was significantly high in group D at T1 (P＜0.05).HR was significantly low in group C at T4 and T5 (P＜0.05).In addition,HR decreased in group D at T1-8(P＜0.05 ),and HR was lower in group D than in group C at T1-3 and T6-8(P＜0.05 ).Conclusion 0.6 μg/ kg Dex given intravenously before induction is beneficial to general anesthesia patients undergoing laparoscopic cholecystectomy.