中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2013年
11期
1339-1341
,共3页
于明懂%苗鲁民%于泳浩%王维
于明懂%苗魯民%于泳浩%王維
우명동%묘로민%우영호%왕유
右美托咪啶%麻醉药,吸入%剂量效应关系,药物
右美託咪啶%痳醉藥,吸入%劑量效應關繫,藥物
우미탁미정%마취약,흡입%제량효응관계,약물
Dexmedetomidine%Anesthetics,inhalation%Dose-response relationship,drug
目的 探讨不同剂量右美托咪定对病人七氟醚镇静最低肺泡有效浓度(MAC)的影响.方法 择期全麻下腹部手术病人,ASA分级Ⅰ或Ⅱ级,年龄18～64岁,性别不限,采用随机数字表法分为4组:对照组(C组)和不同剂量右美托咪定组(D1组、D2组和D3组),D1组、D2组及D3组分别静脉输注负荷量右美托咪定0.4、0.6、0.8 μg/kg,经15 min输注完毕,记录心血管不良反应的发生情况,继之分别以0.4、0.6、0.8 μg·kg-·h-1的速率静脉输注,C组静脉输注等容量生理盐水.负荷量输注完毕后,采用序贯法进行试验,通过调控挥发罐和氧流量使呼气末七氟醚浓度迅速达到目标浓度,C组、D1组、D2组及D3组起始呼气末七氟醚浓度分别为0.8％、0.7％、0.6％和0.5％,并维持此浓度15min,然后由观察者用中等音量的声音指令病人睁眼,出现睁眼反应,下一例病人七氟醚浓度升高1个浓度梯度,否则下一例病人降低1个浓度梯度,相邻浓度比值为0.9,将每次能够做出正确反应与不能够做出正确反应的中点为1个交叉点,直至每组出现第7个交叉点结束.计算七氟醚镇静MAC及其95％可信区间(CI).结果 D3组心血管不良事件发生率明显高于D1,2组(P＜0.05).C组、D1组、D2组及D3组七氟醚MAC及其95％ CI分别为0.68％(0.64％～0.74％)、0.50％(0.47％～0.52％)、0.36％(0.32％ ～ 0.41％)和0.28％ (0.26％ ～ 0.31％).与C组比较,D1-3组七氟醚MAC降低(P＜0.05);与D1组比较,D2组和D3组七氟醚MACe降低(P＜0.05);与D2组比较,D3组七氟醚MAC降低(P＜0.05).结论 右美托咪定0.6 μg/kg既可明显降低病人七氟醚镇静MAC,又无不良反应发生,为适宜剂量.
目的 探討不同劑量右美託咪定對病人七氟醚鎮靜最低肺泡有效濃度(MAC)的影響.方法 擇期全痳下腹部手術病人,ASA分級Ⅰ或Ⅱ級,年齡18～64歲,性彆不限,採用隨機數字錶法分為4組:對照組(C組)和不同劑量右美託咪定組(D1組、D2組和D3組),D1組、D2組及D3組分彆靜脈輸註負荷量右美託咪定0.4、0.6、0.8 μg/kg,經15 min輸註完畢,記錄心血管不良反應的髮生情況,繼之分彆以0.4、0.6、0.8 μg·kg-·h-1的速率靜脈輸註,C組靜脈輸註等容量生理鹽水.負荷量輸註完畢後,採用序貫法進行試驗,通過調控揮髮罐和氧流量使呼氣末七氟醚濃度迅速達到目標濃度,C組、D1組、D2組及D3組起始呼氣末七氟醚濃度分彆為0.8％、0.7％、0.6％和0.5％,併維持此濃度15min,然後由觀察者用中等音量的聲音指令病人睜眼,齣現睜眼反應,下一例病人七氟醚濃度升高1箇濃度梯度,否則下一例病人降低1箇濃度梯度,相鄰濃度比值為0.9,將每次能夠做齣正確反應與不能夠做齣正確反應的中點為1箇交扠點,直至每組齣現第7箇交扠點結束.計算七氟醚鎮靜MAC及其95％可信區間(CI).結果 D3組心血管不良事件髮生率明顯高于D1,2組(P＜0.05).C組、D1組、D2組及D3組七氟醚MAC及其95％ CI分彆為0.68％(0.64％～0.74％)、0.50％(0.47％～0.52％)、0.36％(0.32％ ～ 0.41％)和0.28％ (0.26％ ～ 0.31％).與C組比較,D1-3組七氟醚MAC降低(P＜0.05);與D1組比較,D2組和D3組七氟醚MACe降低(P＜0.05);與D2組比較,D3組七氟醚MAC降低(P＜0.05).結論 右美託咪定0.6 μg/kg既可明顯降低病人七氟醚鎮靜MAC,又無不良反應髮生,為適宜劑量.
목적 탐토불동제량우미탁미정대병인칠불미진정최저폐포유효농도(MAC)적영향.방법 택기전마하복부수술병인,ASA분급Ⅰ혹Ⅱ급,년령18～64세,성별불한,채용수궤수자표법분위4조:대조조(C조)화불동제량우미탁미정조(D1조、D2조화D3조),D1조、D2조급D3조분별정맥수주부하량우미탁미정0.4、0.6、0.8 μg/kg,경15 min수주완필,기록심혈관불량반응적발생정황,계지분별이0.4、0.6、0.8 μg·kg-·h-1적속솔정맥수주,C조정맥수주등용량생리염수.부하량수주완필후,채용서관법진행시험,통과조공휘발관화양류량사호기말칠불미농도신속체도목표농도,C조、D1조、D2조급D3조기시호기말칠불미농도분별위0.8％、0.7％、0.6％화0.5％,병유지차농도15min,연후유관찰자용중등음량적성음지령병인정안,출현정안반응,하일례병인칠불미농도승고1개농도제도,부칙하일례병인강저1개농도제도,상린농도비치위0.9,장매차능구주출정학반응여불능구주출정학반응적중점위1개교차점,직지매조출현제7개교차점결속.계산칠불미진정MAC급기95％가신구간(CI).결과 D3조심혈관불량사건발생솔명현고우D1,2조(P＜0.05).C조、D1조、D2조급D3조칠불미MAC급기95％ CI분별위0.68％(0.64％～0.74％)、0.50％(0.47％～0.52％)、0.36％(0.32％ ～ 0.41％)화0.28％ (0.26％ ～ 0.31％).여C조비교,D1-3조칠불미MAC강저(P＜0.05);여D1조비교,D2조화D3조칠불미MACe강저(P＜0.05);여D2조비교,D3조칠불미MAC강저(P＜0.05).결론 우미탁미정0.6 μg/kg기가명현강저병인칠불미진정MAC,우무불량반응발생,위괄의제량.
Objective To investigate the effects of different doses of dexmedetomidine on the minimum alveolar concentration (MAC) of sevoflurane for sedation in patients.Methods ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 18-64 yr,undergoing elective lower abdominal surgery performed under general anesthesia,were randomly divided into 4 groups:control group (group C) and different doses of dexmedetomidine groups (D1,D2 and D3 groups).In D1,D2 and D3 groups,the loading dose of dexmedetomidine 0.4,0.6 and 0.8 μg/ kg was intravenously infused over 15 min,respectively,adverse cardiovascular events were then recorded,followed by infusion at 0.4,0.6 and 0.8 μg· kg-1 · h-1 via a pump,respectively,while in group C,the equal volume of 0.9 ％ normal saline was given instead of dexmedetomidine.Sevoflurane administration was begun after completion of infusion of the loading dose.Up-and-down sequential allocation was used to determine the MAC.The initial end-tidal concentration of sevoflurane was set at 0.8％,0.7％,0.6％ and 0.5％ in C,D1,D2 and D3 groups,respectively,and maintained at this level for 15 min.Each time the concentration of sevoflurane increased/decreased in the next patient depending on whether or not the patients correctly followed the verbal command to open his eyes.The ratio between the two consecutive concentrations was 0.9.The middle point between the positive response and negative response served as a crossover pair.After at least 7 independent crossover pairs were observed in each group,the experiment was stopped.The MAC and 95 ％ confidence interval of sevoflurane were calculated.Results The incidence of adverse cardiovascular events was significantly higher in D3 group than in D1 and D2 groups (P ＜ 0.05).In C,D1,D2 and D3 groups,the MAC (95％ confidence interval) of sevoflurane was 0.68％ (0.64％-0.74％),0.50％ (0.47％-0.52％),0.36％ (0.32％-0.41％) and 0.28％(0.26％-0.31％),respectively.The MAC-awake of sevoflurane was significantly lower in D1-3 groups than in group C,in D2 and D3 groups than in group D1,and in D3 group than in group D2 (P ＜ 0.05).Conclusion Dexmedetomidine 0.6μg/kg can significantly decrease the MAC of sevoflurane for sedation,induces no side effects and is the optimum dose in patients.
