CAJ | 학술논문

目的探讨复合异丙酚麻醉诱导时右美托咪定的适宜剂量.方法择期行全身麻醉下眼科手术患者120例,年龄18～60岁,体重指数BMI 18.5 ～ 30.0 kg/m2,性别不限,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将其分为6组(n=20):生理盐水组(NS组)、不同剂量右美托咪定组(D1组-D5组).D1组-D5组分别静脉输注负荷量右美托咪定(以生理盐水稀释至50 ml)0.2 μg/kg(D1组)、0.4μg/kg(D2组)、0.6 μg/kg(D3组)、0.8 μg/kg(D4组)和1.0 μg/kg(D5组),NS组以等容量生理盐水替代,15min内输注完毕.观察10 min后,采用序贯法TCI异丙酚,以患者意识消失为阳性反应,起始血浆靶浓度为3.2 μg/ml.计算TCI异丙酚使患者意识消失的半数有效浓度(EC50)及其95％可信区间(Cl).于右美托咪定给药后,TCI异丙酚前记录不良反应的发生情况.结果与NS组比较,D2组-D5组TCI异丙酚使患者意识消失的EC50降低(P＜0.05),D1组TCI异丙酚使患者意识消失的EC50差异无统计学意义(P＞0.05).D1组与D2组、D2组与D3组、D4组与D5组间TCI异丙酚使患者意识消失的EC50随剂量增加逐渐降低(P ＜0.05或0.01),D3组与D4组间TCI异丙酚使患者意识消失的EC50差异无统计学意义(P＞0.05).D3组、D4组、D5组低血压的发生率分别为5％、11％、31％,心动过缓的发生率分别为0、11％、19％,D1组和D2组未见低血压和心动过缓的发生.与NS组、D1组、D2组和D3组比较,D4组与D5组低血压和心动过缓的发生率升高(P＜0.01).结论复合异丙酚麻醉诱导时右美托咪定的适宜剂量为0.4 μg/kg.
목적 탐토복합이병분마취유도시우미탁미정적괄의제량.방법 택기행전신마취하안과수술환자120례,년령18～60세,체중지수BMI 18.5 ～ 30.0 kg/m2,성별불한,ASA분급Ⅰ혹Ⅱ급,채용수궤수자표법,장기분위6조(n=20):생리염수조(NS조)、불동제량우미탁미정조(D1조-D5조).D1조-D5조분별정맥수주부하량우미탁미정(이생리염수희석지50 ml)0.2 μg/kg(D1조)、0.4μg/kg(D2조)、0.6 μg/kg(D3조)、0.8 μg/kg(D4조)화1.0 μg/kg(D5조),NS조이등용량생리염수체대,15min내수주완필.관찰10 min후,채용서관법TCI이병분,이환자의식소실위양성반응,기시혈장파농도위3.2 μg/ml.계산TCI이병분사환자의식소실적반수유효농도(EC50)급기95％가신구간(Cl).우우미탁미정급약후,TCI이병분전기록불량반응적발생정황.결과 여NS조비교,D2조-D5조TCI이병분사환자의식소실적EC50강저(P＜0.05),D1조TCI이병분사환자의식소실적EC50차이무통계학의의(P＞0.05).D1조여D2조、D2조여D3조、D4조여D5조간TCI이병분사환자의식소실적EC50수제량증가축점강저(P ＜0.05혹0.01),D3조여D4조간TCI이병분사환자의식소실적EC50차이무통계학의의(P＞0.05).D3조、D4조、D5조저혈압적발생솔분별위5％、11％、31％,심동과완적발생솔분별위0、11％、19％,D1조화D2조미견저혈압화심동과완적발생.여NS조、D1조、D2조화D3조비교,D4조여D5조저혈압화심동과완적발생솔승고(P＜0.01).결론 복합이병분마취유도시우미탁미정적괄의제량위0.4 μg/kg.
Objective To investigate the optimum dose of dexmedetomidine when combined with propofol for induction of anesthesia.Methods One hundred and twenty ASA physical status Ⅰ or 1Ⅱ patients of beth sexes,aged 18-60 yr,with body mass index of 18.5-30.0 kg/m2,scheduled for elective ophthalmologic operation under general anesthesia,were randomly divided into 6 groups (n =20 each) using a random number table:normal saline group (NS group) and different doses of dexmedetomidine groups (D1-D5 groups).Different loading doses of dexmedetomidine 0.2,0.4,0.6,0.8 and 1.0 μg/kg (in normal saline 50 ml) were infused intravenously in D1-D5 groups,respectively.The equal volume of normal saline was infused over 15 min in group NS.After 10 min observation,target-controlled infusion (TCI) of propofol was started.The initial target plasma concentration was set at 3.2 μg/ml.Loss of consciousness was considered to be positive response.The median effective concentration (EC50) and 95％ confidence interval of propofol TCI required for loss of consciousness were calculated.After administration of dexmedetomidine,the development of adverse effects was recorded before propofol TCI.Results Compared with NS group,the EC50 of propofol TCI required for loss of consciousness was significantly decreased in D2-D5 groups,and no significant change was found in the EC50 of propofol TCI required for loss of consciousness in D1 group.The EC50 of propofol TCI was decreased gradually with the increasing doses of dexmedetomidine between D1 and D2 groups,between D2 and D3 groups,and between D4 and D5 groups,while there was no significant difference in the EC50 of propofol TCI required for loss of consciousness between D3 and D4 groups.The incidence of hypotension was 5％ (D3 group),11％ (D4 group) and 31％ (D5 group),and the incidence of bradycardia was 0 (D3 group),11％ (D4 group),and 19 ％ (D5 group).No hypotension and bradycardia developed in D1 and D2 groups.The incidence of hypotension and bradycardia was significant increased in D4 and D5 groups as compared with NS,D1,D2 and D3 groups.Conclusion The optimum dose of dexmedetomidine is 0.4μg/kg when combined with propofol for induction of anesthesia.