CAJ | 학술논문

目的比较妇科腹腔镜手术患者使用右美托咪啶复合七氟醚与瑞芬太尼复合七氟醚麻醉的效果.方法择期拟行妇科腹腔镜手术患者40例,年龄18～64岁,BMI 18～30 kg/m2,ASA分级Ⅰ或Ⅱ级.采用随机数字表法,将患者随机均分为2组(n=20):右美托咪啶复合麻醉组(D组)和瑞芬太尼复合麻醉组(R组).D组和R组麻醉诱导前5 min时静脉输注右美托咪啶0.05μg·kg·min-1或瑞芬太尼0.1μg·kg-1·min-1,10 min后输注速率为右美托咪啶0.3μg·kg-1·h-1,瑞芬太尼0.15μg·kg-1·min-1.麻醉诱导:静脉注射异丙酚1.5～2.0 mg/kg、顺阿曲库铵0.15 mg/kg和芬太尼2 μg/kg,气管插管后行机械通气,维持PET CO2 35～40 mm Hg.麻醉维持:吸人3%七氟醚,并调节其吸入浓度维持Narcotrend指数40～50,气腹开始时静脉注射芬太尼1 μg/kg,按需静脉注射顺阿曲库铵.分别于给药前、气管插管后5 min、气腹10 min和气管拔管后5 min时,抽取颈外静脉血样,测定血清皮质醇、去甲肾上腺素和肾上腺素的浓度,并行血气分析,记录pH值、乳酸和葡萄糖的浓度.记录呼吸恢复时间、睁眼时间、气管拔管时间和定向力恢复时间.记录围术期不良反应的发生情况和术后2 h内镇痛药的使用情况.结果与R组比较,D组气腹10 min时血清去甲肾上腺素和肾上腺素的浓度降低,呼吸恢复时间缩短,睁眼时间延长,气管拔管期间心动过速、术后寒战和恶心呕吐的发生率降低,术后芬太尼的使用率降低(P＜0.05).结论妇科腹腔镜手术患者右美托咪啶复合七氟醚麻醉的效果优于瑞芬太尼复合七氟醚.
목적 비교부과복강경수술환자사용우미탁미정복합칠불미여서분태니복합칠불미마취적효과.방법 택기의행부과복강경수술환자40례,년령18～64세,BMI 18～30 kg/m2,ASA분급Ⅰ혹Ⅱ급.채용수궤수자표법,장환자수궤균분위2조(n=20):우미탁미정복합마취조(D조)화서분태니복합마취조(R조).D조화R조마취유도전5 min시정맥수주우미탁미정0.05μg·kg·min-1혹서분태니0.1μg·kg-1·min-1,10 min후수주속솔위우미탁미정0.3μg·kg-1·h-1,서분태니0.15μg·kg-1·min-1.마취유도:정맥주사이병분1.5～2.0 mg/kg、순아곡고안0.15 mg/kg화분태니2 μg/kg,기관삽관후행궤계통기,유지PET CO2 35～40 mm Hg.마취유지:흡인3%칠불미,병조절기흡입농도유지Narcotrend지수40～50,기복개시시정맥주사분태니1 μg/kg,안수정맥주사순아곡고안.분별우급약전、기관삽관후5 min、기복10 min화기관발관후5 min시,추취경외정맥혈양,측정혈청피질순、거갑신상선소화신상선소적농도,병행혈기분석,기록pH치、유산화포도당적농도.기록호흡회복시간、정안시간、기관발관시간화정향력회복시간.기록위술기불량반응적발생정황화술후2 h내진통약적사용정황.결과 여R조비교,D조기복10 min시혈청거갑신상선소화신상선소적농도강저,호흡회복시간축단,정안시간연장,기관발관기간심동과속、술후한전화악심구토적발생솔강저,술후분태니적사용솔강저(P＜0.05).결론 부과복강경수술환자우미탁미정복합칠불미마취적효과우우서분태니복합칠불미.
Objective To compare the efficacy of dexmedetomidine versus remifentanil in combination with sevoflurane for gynecological laparoscopy. Methods Forty ASA Ⅰ or Ⅱ patients aged 18-64 yr with body mass index of 18-30 kg/m2 undergoing gynecological laparoscopy were randomly assigned to one of two groups ( n =20 each): dexmedetomidine group (group D) and remifentanil group (group R). Starting from 5 min before induction of anesthesia, dexmedetomidine was infused at 0.05 μg · kg - 1 · min- 1 in group D and remifentanil at 0.1 μg· kg- 1· min-1 in group R for 10 min, then dexmedetomidine infusion rate was increased to 0. 3 μg· kg-1 · h-1 and remifentanil infusion rate was increased to 0.15 μg· kg-1 · min-1 . Anesthesia was induced with propofol 1.5-2.0 mg/kg and fentanyl 2 μg/kg. Tracheal intubation was facilitated with cis-atracurium 0.15 mg/kg. Anesthesia was maintained with sevoflurane and fentanyl 1 μg/kg and intermittent iv boluses of cis-atracurium. Narcotrend index was maintained at 40-50. Blood sample was taken from external jugular vein for blood gas analysis and determination of serum concentrations of corticosteroid, norepinephrine and epinephrine before administration, at 5 min after intubation, at 10 min of aeroperitoneum and at 5 min after extubation. The pH value and concentrations of lactic acid and glucose were recorded. The time for recovery of spontaneous breathing, eye-opening time, extubation time, orientation time and perioperative side-effects were recorded. Numeric rating scale was used to assess the intensity of pain during 2 h after operation. The analgesics used were also recorded. Results The serum concentrations of norepinephrine and epinephrine were significanfly lower at 10 min of aeroperitoneum, the time for recovery of spontaneous breathing was shorter, eye-opening time longer and the incidence of shivering and nausea and vomiting lower, the percentage of patients requiring rescue opioids lower in group D than in group R ( P ＜ 0.05). Conclusion The efficacy of dexmedetomidine combined with sevoflurane anesthesia is better than remifentanil combined with sevoflurane anesthesia for gynecological laparoscopy.