CAJ | 학술논문

目的探讨不同剂量右美托咪啶对七氟醚抑制切皮诱发患者体动反应肺泡气最低有效浓度(MAC)的影响.方法择期拟在全麻下行下腹部手术患者,性别不限,年龄18～64岁,体重指数21 ～ 27 kg/m2,ASA分级Ⅰ或Ⅱ级.采用随机数字表法,将其随机分为4组:对照组(C组)和不同剂量右美托咪啶组(D1组、D2组和D3组).麻醉诱导前静脉输注右美托咪啶(生理盐水稀释至15 ml)0.2μg/kg(D1组)、0.4 μg/kg(D2组)、0.6μg/kg(D3组)或生理盐水15 ml(C组),30 min内输注完毕.4组均采用吸入七氟醚麻醉诱导,气管插管后行机械通气.采用序贯法确定麻醉维持期间呼气末七氟醚浓度.C组、D1组、D2组及D3组第1例患者呼气末七氟醚浓度分别设定为3.0％、3.0％、2.5％和2.0％,预定呼气末七氟醚浓度稳定15 min时进行切皮.评估患者切皮时体动反应,当发生体动反应时,上调一个浓度梯度,否则下调一个浓度梯度,相邻浓度比值为0.9,根据前一例患者是否发生体动反应确定下一例患者呼气末七氟醚浓度,直至每组出现第7个交叉点.以各交叉点呼气末七氟醚浓度的均数作为MAC值,并计算95％可信区间 (CI).结果 C组、D1组、D2组和D3组入选病例分别18、20、20、22例；C组、D1组、D2组和D3组七氟醚MAC值(95％CI)分别为2.5％(2.3％～2.8％)、1.5％(1.3％～1.7％)、1.3％(1.0％～1.6％)和1.1％(0.7％～ 1.5％).与C组比较,D1组～D3组七氟醚MAC值降低(P＜0.05)；与D1组比较,D2组和D3组七氟醚MAC值降低(P＜0.05)；D2组和D3组七氟醚MAC值差异无统计学意义(P＞0.05).结论右美托咪啶0.2、0.4、0.6 μg/kg可明显降低七氟醚抑制手术患者切皮诱发体动反应的MAC值,且呈剂量依赖性.
목적 탐토불동제량우미탁미정대칠불미억제절피유발환자체동반응폐포기최저유효농도(MAC)적영향.방법 택기의재전마하행하복부수술환자,성별불한,년령18～64세,체중지수21 ～ 27 kg/m2,ASA분급Ⅰ혹Ⅱ급.채용수궤수자표법,장기수궤분위4조:대조조(C조)화불동제량우미탁미정조(D1조、D2조화D3조).마취유도전정맥수주우미탁미정(생리염수희석지15 ml)0.2μg/kg(D1조)、0.4 μg/kg(D2조)、0.6μg/kg(D3조)혹생리염수15 ml(C조),30 min내수주완필.4조균채용흡입칠불미마취유도,기관삽관후행궤계통기.채용서관법학정마취유지기간호기말칠불미농도.C조、D1조、D2조급D3조제1례환자호기말칠불미농도분별설정위3.0％、3.0％、2.5％화2.0％,예정호기말칠불미농도은정15 min시진행절피.평고환자절피시체동반응,당발생체동반응시,상조일개농도제도,부칙하조일개농도제도,상린농도비치위0.9,근거전일례환자시부발생체동반응학정하일례환자호기말칠불미농도,직지매조출현제7개교차점.이각교차점호기말칠불미농도적균수작위MAC치,병계산95％가신구간 (CI).결과 C조、D1조、D2조화D3조입선병례분별18、20、20、22례；C조、D1조、D2조화D3조칠불미MAC치(95％CI)분별위2.5％(2.3％～2.8％)、1.5％(1.3％～1.7％)、1.3％(1.0％～1.6％)화1.1％(0.7％～ 1.5％).여C조비교,D1조～D3조칠불미MAC치강저(P＜0.05)；여D1조비교,D2조화D3조칠불미MAC치강저(P＜0.05)；D2조화D3조칠불미MAC치차이무통계학의의(P＞0.05).결론 우미탁미정0.2、0.4、0.6 μg/kg가명현강저칠불미억제수술환자절피유발체동반응적MAC치,차정제량의뢰성.
Objective To investigate the effects of different doses of dexmedetomidine on the minimum alveolar concentration (MAC) of sevoflurane required to inhibit the body movement evoked by skin incision.Methods ASA Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,with body mass index of 21-27 kg/m2,undegoing elective lower abdominal surgery under general anesthesia,were randomly divided into 4 groups:control group (group C) and different doses of dexmedetomidine groups (groups D1,D2 and D3 ).Dexmedetomidine 0.2,0.4 and 0.6 μg/kg in 15 ml of normal saline was infused over 30 min before induction of anesthesia in groups D1,D2 and D3 respectively.While 15 ml of normal saline was given instead in group C.Anesthesia was induced with inhalation of 8％ sevoflurane.The patients were mechanically ventilated after tracheal intubation.Anesthesia was maintained with inhalation of sevoflurane.The initial end-tidal concentration of sevoflurane was set at 3.0％,3.0％,2.5％,2.0％ in groups C,D1,D2 and D3 respectively.The ratio between the two successive concentrations was 0.9.Skin incision was made after 15 min of equilibratiton.At least 7 independent crossover pairs were observed in each group.The MAC of sevoflurane was the mean of the end-tidal concentration of sevoflurane of each crossover pair,and 95 ％ confidence interval (CI) was calculated.Results In groups C,D1,D2 and D3,18,20,20 and 22 patients were enrolled respectively.The MAC (95 ％ CI) of sevoflurane was 2.5 ％ (2.3 ％-2.8 ％ ),1.5 ％ ( 1.3 ％-1.7％),1.3％ (1.0％-1.6％) and 1.1％ (0.7％-1.5％) in groupsC,D1,D2 and D3 respectively.The MAC of sevoflurane was significantly lower in groups D1,D2,D3 than in group C,and in groups D2 and D3 than in group D1 ( P ＜ 0.05).There was no significant difference in the MAC of sevoflurane between groups D2 and D3 ( P ＞0.05).Conclusion Dexmedetomidine 0.2,0.4,0.6 μg/kg can significantly decrease the MAC of sevoflurane required to inhibit the body movement evoked by skin incision in a dose-dependent manner.