CAJ | 학술논문

目的探讨右美托咪啶对异氟醚抑制切皮时患者体动反应的肺泡气最低有效浓度(MAC)的影响.方法择期全身麻醉下行上腹部手术患者,年龄40～60岁,ASA分级Ⅰ或Ⅱ级,体重指数22～27 kg/m2,采用随机数字表法,将患者随机分为3组:对照组(C组)、小剂量右美托咪啶组(D1组)和大剂量右美托咪啶组(D2组).麻醉诱导前静脉输注右美托咪啶(生理盐水稀释至15 ml)0.4 μg/kg(D1组)、0.8μg/kg(D2组)及生理盐水15 ml(C组),15 min内输注完毕.静脉注射芬太尼-异丙酚-琥珀酰胆碱麻醉诱导,气管插管后机械通气并开启异氟醚挥发罐.采用序贯法确定麻醉维持期间异氟醚的呼气末浓度,C组、D1组和D2组第1例患者异氟醚呼气末浓度分别设定为1.0%、0.8%和0.6%,当异氟醚呼气末浓度达到预设水平并维持15 min以上,且肌颤搐恢复到对照值90%以上时开始手术,相邻浓度差值为0.2%.于切皮时评估患者体动反应,以各交叉点异氟醚呼气末浓度的均数为MAC,并计算95%可信区间(CI).结果 C组、D1组和D2组入选病例分别为15、17和16例.异氟醚抑制切皮时体动反应的MAC及其95%CI分别为:C组(1.03±0.23)%(95%CI 0.83%～1.21%)、D1组(0.72±0.19)%(95%CI 0.58%～0.85%)、D2组(0.51±0.27)%(95%CI 0.30%～0.71%).与C组比较,D1组和D2组MAC降低(P＜0.01),D2组MAC明显低于D1组(P＜0.05).结论右美托咪啶可明显降低异氟醚抑制切皮时患者体动反应的MAC,且与剂量有关.
목적 탐토우미탁미정대이불미억제절피시환자체동반응적폐포기최저유효농도(MAC)적영향.방법 택기전신마취하행상복부수술환자,년령40～60세,ASA분급Ⅰ혹Ⅱ급,체중지수22～27 kg/m2,채용수궤수자표법,장환자수궤분위3조:대조조(C조)、소제량우미탁미정조(D1조)화대제량우미탁미정조(D2조).마취유도전정맥수주우미탁미정(생리염수희석지15 ml)0.4 μg/kg(D1조)、0.8μg/kg(D2조)급생리염수15 ml(C조),15 min내수주완필.정맥주사분태니-이병분-호박선담감마취유도,기관삽관후궤계통기병개계이불미휘발관.채용서관법학정마취유지기간이불미적호기말농도,C조、D1조화D2조제1례환자이불미호기말농도분별설정위1.0%、0.8%화0.6%,당이불미호기말농도체도예설수평병유지15 min이상,차기전휵회복도대조치90%이상시개시수술,상린농도차치위0.2%.우절피시평고환자체동반응,이각교차점이불미호기말농도적균수위MAC,병계산95%가신구간(CI).결과 C조、D1조화D2조입선병례분별위15、17화16례.이불미억제절피시체동반응적MAC급기95%CI분별위:C조(1.03±0.23)%(95%CI 0.83%～1.21%)、D1조(0.72±0.19)%(95%CI 0.58%～0.85%)、D2조(0.51±0.27)%(95%CI 0.30%～0.71%).여C조비교,D1조화D2조MAC강저(P＜0.01),D2조MAC명현저우D1조(P＜0.05).결론 우미탁미정가명현강저이불미억제절피시환자체동반응적MAC,차여제량유관.
Objective To investigate the effect of dexmedetomidine on minimum alveolar concentration (MAC) of isoflurane required to inhibit the body movement during skin incision. Methods Forty-eight ASA Ⅰ or Ⅱ patients aged 40-60 yr with body mass index of 22-27 kg/m2 undergoing elective upper abdominal surgery under general anesthesia were randomly divided into 3 groups: control group (group C, n = 15);low dose dexmedetomidine group (group D1, n = 17) and high dose dexmedetomidine group (group D2, n = 16). The patients were unpremedicated. Dexmedetomidine 0.4 and 0.8 μg/kg in normal saline (NS) 15 ml was infused over 15 min before induction of anesthesia in D1 and D2 groups respectively. Anesthesia was induced with fentanyl-propofol-succinylcholine. The patients were mechanically ventilated after tracheal intubation. Anesthesia was maintained with isoflurane. MAC of isoflurane was determined by up-and-down technique. The initial end-tidal isofiurane concentration was set at 1.0%, 0.8% and 0.6% in C, D1 and D2 groups respectively. Each time the end-tidal isoflurane concentration was increased/decreased by 0.2%. Skin incision was made after 15 min of equilibration, when the twitch height returned to more than 90% of its control value. Movement of body and limbs including swallowing and coughing were carefully looked for when skin incision was made. MAC of isoflurane was the mean of end-tidal concentration of isoflurane of each crossover pair, and 95 % CI was calculated. Results MAC of isoflurane was significantly decreased in D1 and D2 groups as compared with group C and in group D2 as compared with group D1( P ＜ 0.05 or 0.01 ). Conclusion Dexmedetomidine can significantly decrease MAC of isoflurane required to inhibit the body movement during skin incision in a dose-dependent manner.