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
2015年
1期
23-26
,共4页
袁静静%李治松%张卫%文帅
袁靜靜%李治鬆%張衛%文帥
원정정%리치송%장위%문수
右美托咪定%丙泊酚%麻醉,全身%骨科手术
右美託咪定%丙泊酚%痳醉,全身%骨科手術
우미탁미정%병박분%마취,전신%골과수술
Dexmedetomidine%Propofol%Anesthesia,general%Orthopedic surgery
目的 观察静脉滴注右美托咪定(dexmedetomidine,Dex)对骨科全麻手术血流动力学及苏醒期的影响,探索合适的Dex静脉滴注的剂量和方法. 方法 美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级择期全麻骨科手术患者100例,采用随机数字表法将患者分为4组(每组25例):D1组、D2组、D3组和C组,D1、D2组和D3组患者全麻诱导前10 min静脉滴注负荷量Dex 0.6 μg/kg,再分别静脉滴注Dex 0.2、0.4 μg· kg-1·h-1和0.8 μg· kg-1·h-1,C组全程静脉滴注等量生理盐水,手术结束前30 min停止静脉滴注Dex.以脑电双频指数(bispectral index,BIS)作为麻醉镇静深度指标,术中根据BIS值调节丙泊酚用量以维持麻醉.记录用药前、插管前1 min、插管后1 min、切皮、拔管前1 min及拔管后1 min各时间点血流动力学参数及丙泊酚用量,术后患者睁眼时间、拔管时间、定向力恢复时间及术后在麻醉后监测治疗室(postanesthesia care unit,PACU)期间副作用发生情况.结果 与C组比较,D1组、D2组和D3组患者的心率(heart rate,HR)在插管后1 min和拔管后1 min均明显降低(P＜0.01),收缩压(systolic blood pressure,SBP)和舒张压(diastolic blood pressure,DBP)在插管后1 min、切皮时和拔管后1 min均明显降低(P＜0.05).在相同镇静条件下,C组、D1组、D2组和D3组丙泊酚用量分别为1 180、1 095、822、696 mg,Dex以剂量依赖方式降低术中丙泊酚用量(P＜0.05).4组患者睁眼时间、拔管时间和定向力恢复时间比较,差异均无统计学意义(P＞0.05).与C组比较,D1组、D2组和D3组患者术后在PACU期间躁动、恶心呕吐及呼吸抑制发生率明显降低(P＜0.05),但D3组患者嗜睡发生率较高(P＜0.05). 结论 术中持续静脉滴注0.2 μg·kg-1·h-1～0.4 μg·kg-1·h-1 Dex可维持骨科全麻患者血流动力学稳定,预防气管插管、切皮和拔管引起的心血管反应,减少术中丙泊酚用量,降低术后副作用.
目的 觀察靜脈滴註右美託咪定(dexmedetomidine,Dex)對骨科全痳手術血流動力學及囌醒期的影響,探索閤適的Dex靜脈滴註的劑量和方法. 方法 美國痳醉醫師協會(ASA)分級Ⅰ～Ⅱ級擇期全痳骨科手術患者100例,採用隨機數字錶法將患者分為4組(每組25例):D1組、D2組、D3組和C組,D1、D2組和D3組患者全痳誘導前10 min靜脈滴註負荷量Dex 0.6 μg/kg,再分彆靜脈滴註Dex 0.2、0.4 μg· kg-1·h-1和0.8 μg· kg-1·h-1,C組全程靜脈滴註等量生理鹽水,手術結束前30 min停止靜脈滴註Dex.以腦電雙頻指數(bispectral index,BIS)作為痳醉鎮靜深度指標,術中根據BIS值調節丙泊酚用量以維持痳醉.記錄用藥前、插管前1 min、插管後1 min、切皮、拔管前1 min及拔管後1 min各時間點血流動力學參數及丙泊酚用量,術後患者睜眼時間、拔管時間、定嚮力恢複時間及術後在痳醉後鑑測治療室(postanesthesia care unit,PACU)期間副作用髮生情況.結果 與C組比較,D1組、D2組和D3組患者的心率(heart rate,HR)在插管後1 min和拔管後1 min均明顯降低(P＜0.01),收縮壓(systolic blood pressure,SBP)和舒張壓(diastolic blood pressure,DBP)在插管後1 min、切皮時和拔管後1 min均明顯降低(P＜0.05).在相同鎮靜條件下,C組、D1組、D2組和D3組丙泊酚用量分彆為1 180、1 095、822、696 mg,Dex以劑量依賴方式降低術中丙泊酚用量(P＜0.05).4組患者睜眼時間、拔管時間和定嚮力恢複時間比較,差異均無統計學意義(P＞0.05).與C組比較,D1組、D2組和D3組患者術後在PACU期間躁動、噁心嘔吐及呼吸抑製髮生率明顯降低(P＜0.05),但D3組患者嗜睡髮生率較高(P＜0.05). 結論 術中持續靜脈滴註0.2 μg·kg-1·h-1～0.4 μg·kg-1·h-1 Dex可維持骨科全痳患者血流動力學穩定,預防氣管插管、切皮和拔管引起的心血管反應,減少術中丙泊酚用量,降低術後副作用.
목적 관찰정맥적주우미탁미정(dexmedetomidine,Dex)대골과전마수술혈류동역학급소성기적영향,탐색합괄적Dex정맥적주적제량화방법. 방법 미국마취의사협회(ASA)분급Ⅰ～Ⅱ급택기전마골과수술환자100례,채용수궤수자표법장환자분위4조(매조25례):D1조、D2조、D3조화C조,D1、D2조화D3조환자전마유도전10 min정맥적주부하량Dex 0.6 μg/kg,재분별정맥적주Dex 0.2、0.4 μg· kg-1·h-1화0.8 μg· kg-1·h-1,C조전정정맥적주등량생리염수,수술결속전30 min정지정맥적주Dex.이뇌전쌍빈지수(bispectral index,BIS)작위마취진정심도지표,술중근거BIS치조절병박분용량이유지마취.기록용약전、삽관전1 min、삽관후1 min、절피、발관전1 min급발관후1 min각시간점혈류동역학삼수급병박분용량,술후환자정안시간、발관시간、정향력회복시간급술후재마취후감측치료실(postanesthesia care unit,PACU)기간부작용발생정황.결과 여C조비교,D1조、D2조화D3조환자적심솔(heart rate,HR)재삽관후1 min화발관후1 min균명현강저(P＜0.01),수축압(systolic blood pressure,SBP)화서장압(diastolic blood pressure,DBP)재삽관후1 min、절피시화발관후1 min균명현강저(P＜0.05).재상동진정조건하,C조、D1조、D2조화D3조병박분용량분별위1 180、1 095、822、696 mg,Dex이제량의뢰방식강저술중병박분용량(P＜0.05).4조환자정안시간、발관시간화정향력회복시간비교,차이균무통계학의의(P＞0.05).여C조비교,D1조、D2조화D3조환자술후재PACU기간조동、악심구토급호흡억제발생솔명현강저(P＜0.05),단D3조환자기수발생솔교고(P＜0.05). 결론 술중지속정맥적주0.2 μg·kg-1·h-1～0.4 μg·kg-1·h-1 Dex가유지골과전마환자혈류동역학은정,예방기관삽관、절피화발관인기적심혈관반응,감소술중병박분용량,강저술후부작용.
Objective To investigate the effect of continuous intravenous infusion of different doses of dexmedetomidine (Dex) on the intraoperative hemodynamics and recovery period for orthopedic surgery under general anesthesia,to explore appropriate dose and method of intravenous infusion of Dex.Methods One hundred ASA Ⅰ-Ⅱ patients (weight 50 kg-75 kg) undergoing elective orthopedic surgery were randomly divided into four groups:group D1,group D2,group D3 and group C.The patients in group D1,group D2 and group D3 were all treated with a continuous intravenous drip of 0.6 μg/kg Dex 10 min before the induction of general anesthesia,and followed by a continuous intravenous drip of 0.2,0.4 μg·kg-1 ·h-1 or 0.8 μg ·kg-1 ·h-1 Dex,respectively.The patients in group C were treated with the same amount of normal saline.The admistration of Dex was stopped 30 min before the end of surgery.Patients in the four groups were treated with same method of anesthesia.The amount of propofol was adjustted based on bispectral index (BIS),which was the indicator of the depth of sedation,to maintain anesthesia.The changes of hemodynamic parameters at the time premedication,1 min before and after tracheal intubation,insion,1 min before and after tracheal extubation,the consumption of propofol,postoperative recovery time to eyes opening,extubation and orientation,and the incidence of agitation,nausea and vomiting,respiratory depression and somnolence were recorded.Results The heart rate (HR) of the time 1 min after tracheal intubation and extubation was lower than that in group C (P＜0.01).The systolic blood pressure(SBP) and diastolic blood pressure(DBP) at the time 1 min after tracheal intubation,insion and 1 min after extubation were all lower than that in group C(P＜0.05).Under the same sedation conditions,consumption of propofol in group C,D1,D2,D3 was 1 180,1 095,822,696 mg,respectively.Dex reduced the consumption of propofol in a dose-dependent manner (P＜0.05).The difference of recovery time to eyes opening,extubation and orientation in the four groups was not statistically significant (P＞0.05).The incidence of postoperative agitation,nausea and vomiting and respiratory depression in group D1,group D2 and group D3 was significantly lower than that in group C (P＜0.05).But the incidence of somnolence in group D3 was higher compared with group C (P＜0.05).Conclusions Intraoperative continuous intravenous infusion of 0.2 μg· kg-1· h-1-0.4 μg·kg-1·h-1 Dex may effectively maintain stable hemodynamics of patients undergoing orthopedic surgery during general anesthesia,prevent the cardiovascular reactions of tracheal intubation,insion and tracheal extubation,reduce propofol requirement and postoperative adverse reactions,improve the patients outcomes.
