国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2014年
6期
506-509
,共4页
韩永正%刘慧丽%吴长毅%郭向阳
韓永正%劉慧麗%吳長毅%郭嚮暘
한영정%류혜려%오장의%곽향양
右美托咪定%丙泊酚%靶控输注
右美託咪定%丙泊酚%靶控輸註
우미탁미정%병박분%파공수주
Dexmedetomidine%Propofol%Target controlled infusion
目的 观察不同剂量的右美托咪定(dexmedetomidine,Dex)对术中丙泊酚靶控输注(target controlled infusion,TCI)效应室浓度(effect-ite concentration,Ce)及血流动力学的影响. 方法 采用前瞻性、随机、双盲、安慰剂平行对照的研究方法,选择60例在全凭静脉麻醉下择期行腹腔镜单纯胆囊切除术的患者,美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级,采用随机数字表法分为3组,每组20例.Dex 0.4 μg/kg(Dex1组)、Dex 0.5 μg/kg(Dex2组)和等容量生理盐水(NS组)在诱导开始时泵注,泵注时间为10 min.同时所有患者均采用相同的麻醉诱导及维持方案.分别于麻醉诱导前(T0)、切皮前(T1)、气腹后1(T2)、5(T3)、l0(T4)、20 min(T5)、放气腹后5 min(T6)记录收缩压(systolic blood pressure,SBP)、心率(heart rate,HR)、丙泊酚Ce.手术结束时记录丙泊酚所用总量. 结果 与NS组比较,Dex2组的SBP在T1时显著升高(P＜0.01);与T0点比较,NS组的SBP在T1、T6点显著降低,Dexl、Dex2组在T1、T5、T6点均有显著降低;NS组丙泊酚使用量[(716±209) mg]显著高于Dex1组和Dex2组[(587±184) mg和(489±158) mg(P＜0.05和P＜0.0l)].Dex2组各时间点丙泊酚Ce均显著低于NS组(P＜0.01),Dexl组在T2～T6时间点丙泊酚Ce显著低于NS组(T6时间点P＜0.05,其余时间点P＜0.01);使用0.4 μg/kg和0.5 μg/kg的Dex约节省丙泊酚18％和32％的用量. 结论 腹腔镜胆囊切除术中单次应用Dex可以维持围术期血流动力学平稳,显著降低术中丙泊酚效应室浓度,减少丙泊酚用量.
目的 觀察不同劑量的右美託咪定(dexmedetomidine,Dex)對術中丙泊酚靶控輸註(target controlled infusion,TCI)效應室濃度(effect-ite concentration,Ce)及血流動力學的影響. 方法 採用前瞻性、隨機、雙盲、安慰劑平行對照的研究方法,選擇60例在全憑靜脈痳醉下擇期行腹腔鏡單純膽囊切除術的患者,美國痳醉醫師協會(ASA)分級Ⅰ～Ⅱ級,採用隨機數字錶法分為3組,每組20例.Dex 0.4 μg/kg(Dex1組)、Dex 0.5 μg/kg(Dex2組)和等容量生理鹽水(NS組)在誘導開始時泵註,泵註時間為10 min.同時所有患者均採用相同的痳醉誘導及維持方案.分彆于痳醉誘導前(T0)、切皮前(T1)、氣腹後1(T2)、5(T3)、l0(T4)、20 min(T5)、放氣腹後5 min(T6)記錄收縮壓(systolic blood pressure,SBP)、心率(heart rate,HR)、丙泊酚Ce.手術結束時記錄丙泊酚所用總量. 結果 與NS組比較,Dex2組的SBP在T1時顯著升高(P＜0.01);與T0點比較,NS組的SBP在T1、T6點顯著降低,Dexl、Dex2組在T1、T5、T6點均有顯著降低;NS組丙泊酚使用量[(716±209) mg]顯著高于Dex1組和Dex2組[(587±184) mg和(489±158) mg(P＜0.05和P＜0.0l)].Dex2組各時間點丙泊酚Ce均顯著低于NS組(P＜0.01),Dexl組在T2～T6時間點丙泊酚Ce顯著低于NS組(T6時間點P＜0.05,其餘時間點P＜0.01);使用0.4 μg/kg和0.5 μg/kg的Dex約節省丙泊酚18％和32％的用量. 結論 腹腔鏡膽囊切除術中單次應用Dex可以維持圍術期血流動力學平穩,顯著降低術中丙泊酚效應室濃度,減少丙泊酚用量.
목적 관찰불동제량적우미탁미정(dexmedetomidine,Dex)대술중병박분파공수주(target controlled infusion,TCI)효응실농도(effect-ite concentration,Ce)급혈류동역학적영향. 방법 채용전첨성、수궤、쌍맹、안위제평행대조적연구방법,선택60례재전빙정맥마취하택기행복강경단순담낭절제술적환자,미국마취의사협회(ASA)분급Ⅰ～Ⅱ급,채용수궤수자표법분위3조,매조20례.Dex 0.4 μg/kg(Dex1조)、Dex 0.5 μg/kg(Dex2조)화등용량생리염수(NS조)재유도개시시빙주,빙주시간위10 min.동시소유환자균채용상동적마취유도급유지방안.분별우마취유도전(T0)、절피전(T1)、기복후1(T2)、5(T3)、l0(T4)、20 min(T5)、방기복후5 min(T6)기록수축압(systolic blood pressure,SBP)、심솔(heart rate,HR)、병박분Ce.수술결속시기록병박분소용총량. 결과 여NS조비교,Dex2조적SBP재T1시현저승고(P＜0.01);여T0점비교,NS조적SBP재T1、T6점현저강저,Dexl、Dex2조재T1、T5、T6점균유현저강저;NS조병박분사용량[(716±209) mg]현저고우Dex1조화Dex2조[(587±184) mg화(489±158) mg(P＜0.05화P＜0.0l)].Dex2조각시간점병박분Ce균현저저우NS조(P＜0.01),Dexl조재T2～T6시간점병박분Ce현저저우NS조(T6시간점P＜0.05,기여시간점P＜0.01);사용0.4 μg/kg화0.5 μg/kg적Dex약절성병박분18％화32％적용량. 결론 복강경담낭절제술중단차응용Dex가이유지위술기혈류동역학평은,현저강저술중병박분효응실농도,감소병박분용량.
Objective To evaluate effects of different doses of dexmedetomidine(Dex) on effect-site concentration (Ce) of propofol with target controlled infusion (TCI) and hemodynamics during operation.Methods A prospective,randomized,doubleblind and placebo controlled clinical protocol was used in this study.According to random number table,sixty patients (ASA Ⅰ-Ⅱ) undergoing laparoscopic cholecystectomy in total intravenous anesthesia were randomly allocated to three groups with 20 patients in each group.When the induction of anesthesia started,Dex 0.4 μg/kg (group Dexl),0.5 μg/kg (group Dex2) or the same volume of normal saline (group NS) was infused intravenously within 10 min.Meanwhile,all patients received the same method of induction and the maintenance of anesthesia.In three groups,the systolic blood pressure (SBP),heart rate (HR),and Ce of propofol were recorded before induction of anesthesia (T0),before skin incision (T1),1 min after pneumoperitoneum (T2),5 min after pneumoperitoneum (T3),10 min after pneumoperitoneum (T4),20 min after pneumoperitoneum (T 5),lifting of pneumoperitoneum after 5 min (T6).At the end of operation,the total dose of propofol was recorded.Results The SBP at T1 in group Dex2 was significantly higher than group NS (P＜0.01).Compared with baseline,the SBP in group NS was significantly lower at T1 and T6.The SBP in group Dex1 and Dex2 were significantly lower at T1,T5,T6.More propofol consumed in group NS [(716±209) mg] than that in group Dex1 and in group Dex2[(587±184) mg and(489±158) mg(P＜0.05)].In each time point,the propofol Ce in group Dex2 was significantly lower than group NS (P＜0.01).From T2 to T6,the propofol Ce in group Dex1 was significantly lower than group NS (T6 time point P＜0.05,other time points P＜0.01).The dosage of propofol decreased by 18％ and 32％ respectively when combined with Dex 0.4 μg/kg and 0.5 μg/kg.Conclusions Infusion of Dex in laparoscopic cholecystectomy can stabilize the hemodynamics while decreasing the propofol Ce and reducing the consumption of of propofol.
