CAJ | 학술논문

目的：研究右美托咪啶辅助全身麻醉在妇科腹腔镜手术中的应用。方法择期行妇科腹腔镜手术患者60例，ASA分级Ⅰ～Ⅱ级。随机分为两组：右美托咪啶组（D组）和对照组（C组），每组30例。D组患者在麻醉诱导前静脉泵注右美托咪啶0．5μg·kg-1（10 min泵注完毕），术中继以0．4μg·kg-1·h-1持续泵注；对照组以同样方式泵注等量0．9％氯化钠。记录两组患者给药前（T0）、插管即刻（T1）、手术开始即刻（T2）、气腹10 min（T3）、拔管即刻（T4）的平均动脉压（MAP）和心率（HR）。记录两组手术时间、麻醉时间、苏醒时间、拔管时间及拔管呛咳反应和苏醒期躁动情况。结果两组手术时间、麻醉时间、苏醒时间、拔管时间比较差异无统计学意义；D组在T1、T2、T3和T4点的MAP、HR低于同时点对照组（P＜0．05）。C组T1～4各时间点MAP、HR均较T0时升高（P＜0．05）。D组拔管呛咳反应和苏醒期躁动的发生率较C组明显减少（P＜0．05）。结论麻醉诱导前静脉泵注右美托咪啶0．5μg·kg-1（10 min泵注完毕），术中继以0．4μg·kg-1·h-1持续泵注可减轻妇科患者腹腔镜手术中循环动力学反应，降低拔管呛咳及苏醒期躁动发生率，从而提高麻醉质量。
목적：연구우미탁미정보조전신마취재부과복강경수술중적응용。방법택기행부과복강경수술환자60례，ASA분급Ⅰ～Ⅱ급。수궤분위량조：우미탁미정조（D조）화대조조（C조），매조30례。D조환자재마취유도전정맥빙주우미탁미정0．5μg·kg-1（10 min빙주완필），술중계이0．4μg·kg-1·h-1지속빙주；대조조이동양방식빙주등량0．9％록화납。기록량조환자급약전（T0）、삽관즉각（T1）、수술개시즉각（T2）、기복10 min（T3）、발관즉각（T4）적평균동맥압（MAP）화심솔（HR）。기록량조수술시간、마취시간、소성시간、발관시간급발관창해반응화소성기조동정황。결과량조수술시간、마취시간、소성시간、발관시간비교차이무통계학의의；D조재T1、T2、T3화T4점적MAP、HR저우동시점대조조（P＜0．05）。C조T1～4각시간점MAP、HR균교T0시승고（P＜0．05）。D조발관창해반응화소성기조동적발생솔교C조명현감소（P＜0．05）。결론마취유도전정맥빙주우미탁미정0．5μg·kg-1（10 min빙주완필），술중계이0．4μg·kg-1·h-1지속빙주가감경부과환자복강경수술중순배동역학반응，강저발관창해급소성기조동발생솔，종이제고마취질량。
Objective To study the effect of dexmedetomidine as an adjunct in general anesthesia for patients undergoing gynecological laparoscopy.Methods Sixty ASAⅠ ~Ⅱ patients undergoing gynecological laparoscopy were randomly assigned into two groups:dexmedetomidine group (group D)and control group (group C)with 30 each.Dexmedetomidine was infused with a bolus of 0.5 μg· kg-1 (infused more than 1 0 min)before anesthesia induction in group D,followed by 0.4 μg·kg-1 ·h-1 continuous infusion.0.9%sodium chloride was infused in the same way in control group.MAP and HR were recorded at the time points of pre-administration of dexmedetomidine (T0 ),immediately after intubation (T1 ),after incision (T2 ),1 0 min after aeroperitioneum (T3 ),immediately af-ter extubation (T4 ).The following variables were also recorded:surgery time,anesthesia time,emergence and extubation time,cough response and restlessness rate.Results There were no significant differences between two groups in surgery time,anesthesia time,e-mergence time and extubation time.MAP,HR in group D were lower than those in control group immediately after intubation (T1 ), after incision (T2 ),1 0min after aeroperitioneum (T3 ),immediately after extubation (T4 )(P<0.05 ).Compared with those at T0, MAP and HR were significantly increased at T1 ~4 in group C(P<0.05).The rates of cough response and restlessness in group D were lower than those in control group(P<0.05 ).Conclusions Dexmedetomidine infused with a bolus of 0.5 μg·kg-1 (infused more than 1 0min)before anesthesia induction,followed by 0.4 μg·kg-1 · h-1 continuous infusion can effectively diminish the patients’ fluctuation of hemodynamics and reduce the rate of patients’cough response and recovery restlessness.It is beneficial to general anes-thesia in patients undergoing gynecological laparoscopy.