CAJ | 학술논문

目的：观察右美托咪定对丙泊酚复合瑞芬太尼全身麻醉中血流动力学及麻药用量的影响。方法选择全身麻醉下行择期妇科腹腔镜手术患者60例，随机分为3组：对照组(P组)、单次输注右美托咪定组(D组)及持续输注右美托咪定组(C组)，每组20例。全身麻醉诱导前，D组静脉泵注右美托咪定0.5μg/kg；C组按同速静脉泵注右美托咪定0.5μg/kg，之后以0.15μg/(kg·h)速率持续泵注至术毕前30 min；P组给予等容积生理盐水。记录患者在注药前(T0)、麻醉诱导前(T1)、插管前(T2)、插管后即刻(T3)、插管后3 min(T4)、气腹后(T5)、术毕停药即刻(T6)、拔管后即刻(T7)和拔管后3 min(T8)的收缩压、舒张压、心率；术中丙泊酚和瑞芬太尼的用量。结果 C组T3、T5、T7时点SBP，T5、T7时点DBP及T1~T7时点HR低于P组，差异均有统计学意义(P<0.05)；D组T3、T5时点SBP及T1~T7时点HR低于P组，差异均有统计学意义(P<0.05)；P组T3、T5、T7时点SBP，T7时点DBP均高于T0时点，T2和T4~T6时点HR均低于T0时点，T7时点HR高于T0时点，差异均有统计学意义(P<0.05)；D组T2~T6时点HR均低于T0时点，差异均有统计学意义(P<0.05)；C组T1~T6时点HR均低于T0时点，差异均有统计学意义(P<0.05)。C组瑞芬太尼用量较P组减少，差异有统计学意义(P<0.01)；3组丙泊酚用量比较差异无统计学意义(P>0.05)。结论持续低剂量输注右美托咪定可以有效减轻全身麻醉腹腔镜手术患者在气管插管、气腹和术后拔管过程中的血流动力学波动，并能减少瑞芬太尼的用量。
목적：관찰우미탁미정대병박분복합서분태니전신마취중혈류동역학급마약용량적영향。방법선택전신마취하행택기부과복강경수술환자60례，수궤분위3조：대조조(P조)、단차수주우미탁미정조(D조)급지속수주우미탁미정조(C조)，매조20례。전신마취유도전，D조정맥빙주우미탁미정0.5μg/kg；C조안동속정맥빙주우미탁미정0.5μg/kg，지후이0.15μg/(kg·h)속솔지속빙주지술필전30 min；P조급여등용적생리염수。기록환자재주약전(T0)、마취유도전(T1)、삽관전(T2)、삽관후즉각(T3)、삽관후3 min(T4)、기복후(T5)、술필정약즉각(T6)、발관후즉각(T7)화발관후3 min(T8)적수축압、서장압、심솔；술중병박분화서분태니적용량。결과 C조T3、T5、T7시점SBP，T5、T7시점DBP급T1~T7시점HR저우P조，차이균유통계학의의(P<0.05)；D조T3、T5시점SBP급T1~T7시점HR저우P조，차이균유통계학의의(P<0.05)；P조T3、T5、T7시점SBP，T7시점DBP균고우T0시점，T2화T4~T6시점HR균저우T0시점，T7시점HR고우T0시점，차이균유통계학의의(P<0.05)；D조T2~T6시점HR균저우T0시점，차이균유통계학의의(P<0.05)；C조T1~T6시점HR균저우T0시점，차이균유통계학의의(P<0.05)。C조서분태니용량교P조감소，차이유통계학의의(P<0.01)；3조병박분용량비교차이무통계학의의(P>0.05)。결론지속저제량수주우미탁미정가이유효감경전신마취복강경수술환자재기관삽관、기복화술후발관과정중적혈류동역학파동，병능감소서분태니적용량。
Objective To observe the effects of dexmedetomidine on hemodynamics and anesthetic dosage during gen-eral anesthesia with propofol combined with remifentanil. Methods Sixty patients underwent gynecological laparoscopic surgery in general anesthesia were selected and randomly divided into 3 groups:control group (Group P,normal saline), single infusion of dexmedetomidine group (Group D,intravenous dexmedetomidine 0.5 μg/kg)and continuous infusion of dexemdetomidine group[Group C,intravenous dexmedetomidine 0.5μg/kg and then constant infusion at 0.15μg/(kg·h)]. SBP,DBP and HR were recorded in the following times:before injection(T0),before anesthetic induction(T1),before intuba-tion(T2),instant after intubation(T3),after intubation of 3 min(T4),after pneumoperitoneum(T5),drug withdrawal immediately after surgery(T6),instant after extubation(T7)and after extubationof 3 min(T8).The dosage of propofol and remifentanil were recorded during the surgery. Results SBP at T3,T5 and T7,DBP at T5 and T7,HR at T1-T7 in group C was lower than that in group P respectively,with statistical difference (P<0.05).SBP at T3,T5,HR at T1-T7 in group D was lower than that in group P respectively,with statistical difference (P<0.05). In group P,SBP at T3,T5 and T7,DBP at T7 was higher than that T0 respectively,HR at T2,T4-T6 was lower than that T0 respectively,HR at T7 was higher than that T0, with statistical difference(P<0.05).In group C,HR at T1-T6 was lower than that T0 respectively,with statistical difference (P<0.05).The dosage of remifentanil in group C was less than that in goup P,with statistical difference (P<0.01).The dosage of propofol in three groups was compared,with no statistical difference (P>0.05). Conclusion Con-tinuous infusion of dexemdetomidine with low dose can effectively reduce the hemodynamic fluctuation in endotracheal intubation,pneumoperitoneum and extubation from patients during general anesthesia in laparoscopic operation,as well as decrease the dosage of remifentanil.