|摘要||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.
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.|