| 1 | 0 | 53 |
| 下载次数 | 被引频次 | 阅读次数 |
目的:观察右美托咪定辅助颈椎手术静脉全麻时丙泊酚用量和对术中血压、心率的影响。方法:选择40例行颈椎手术的颈椎受限患者,随机分成右美托咪定+丙泊酚+瑞芬太尼组(D组,n=20)和生理盐水+丙泊酚+瑞芬太尼组(N组,n=20)。D组于诱导前10 min静脉泵注右美托咪啶1μg/kg,N组静脉泵注相同容量的生理盐水。术中以瑞芬太尼(血浆浓度,4 ng/mL)和丙泊酚(血浆浓度,据术中血压调节)靶控输注维持麻醉。结果:丙泊酚用量D组、N组分别为(1422.75±180.72)mg和(1902.50±151.64)mg,D组明显减少(P<0.01);瑞芬太尼用量D组、N组分别为(2617.60±144.68)μg和(2642.25±63.37)μg,两组无明显差异(P>0.05)。术中最低MAP、切皮时、术中最低及术中最高HR,D组明显较低(P<0.05)。组内术前、切皮时和术中最高指标比较,两组MAP均无明显差异(P>0.05),D组术前HR高于切皮时和最高HR,后两者间无明显差异。N组最高HR大于术前、切皮时HR(P<0.05),后两者间无明显差异(P>0.05)。结论:右美托咪啶辅助颈椎手术静脉全麻显著减少丙泊酚用量,是有效、安全的静脉全麻的辅助用药。
Abstract：Objective: To investigate the effect of propofol consumption with the adjuvant ofdexmedetomidine to intraoperative blood pressure and heart rate in patients undergoing cervical operations withtotal intravenous anesthesia.Methods: 40 patients accepted cervical operations were randomly allocated in twogroups: Dexmedetomidine + propofol + remifentanil group( group D,n= 20), and normal saline + propofol +remifentanil group( group N,n= 20). 1.0μg/ kg Dexmedetomidine was administered in group D 10 minutesbefore the induction. Meanwhile the same volume of normal saline was administered in group N. Anesthesia wasmaintained by a target-controlled infusion(TCI) of remifentanil(plasma concentration, 4 ng/ mL) and propofol(plasma concentration, infusion rate regulated by intraoperative blood pressure).Results: Propofol consumptionwas significantly less in group D than in group N(1422.75±180.72 vs.1902.50±151.64;P<0.01). There was nosignificant difference of remifentanil consumption between the two groups(2617.60±144.6vs.2642.25±63.37;P>0.05). The minimal MAP, incision HR, intraoperative minimal and maximum HR in group D was significantlyless(P<0.05). Comparing the maximum HR of preoperation, incision and intraoperation in intra-group, therewas no significant difference between the two groups in MAPs(P>0.05). And pre-operative HR was higher thanincision and maximum HR in group D, and there was no significant difference between the latter two indicators.The maximum HR was higher than pre-operative and incision HR in group N(P< 0.05), and there was nosignificant difference between the latter two indicators(P>0.05).Conclusion: Dexmedetomidine as an adjuvantcan significantly reduce Propofol consumption in total intravenous anesthesia( TIVA) of cervical operations,which is an effective and safe adjunct to TIVA.
[1]Gerlach AT,Murphy CV,Dasta JF.An updated focusedreview of dexmedetomidine in adults[J].AnnPharmacother,2009,43(12):2064-2074.
[2]Aantaa R,Jaakola ML,Kallio A,et al.Reduction of the minimum alveolar concentration of isoflurane bydexmedetomidine[J].Anesthesiology,1997,86(5):1055-1060.
[3]Chrysostomou C,Schmitt CG.Dexmedetomidine:sedation,analgesia and beyond[J].Expert Opin Drug MetabToxicol,2008,4(5):619-627.
[4]区锦燕,刘晓捷,陈耀雄,等.右美托咪定清醒镇静对颈椎受限患者经鼻插管时血压和心率的影响[J].广东医学,2012,19(33):2986-2989.
[5]Dutta S,Karol MD,Cohen T,et al.Effect ofdexmedetomidine on propofol requirements in healthysubjects[J].J Pharm Sci 2001,90(2):172-181.
[6]Ngwenyama NE,Anderson J,Hoernschemeyer DG,et al.Effects of dexmedetomidine on propofol and remifentanilinfusion rates during total intravenous anesthesia for spinesurgery in adolescents[J].Paediatr Anaesth,2008,18(12):1190-1150.
[7]Kamibayashi T,Maze M.Clinical uses of alpha2-adrenergicagonists[J].Anesthesiology 2000,93(5):1345-1349.
[8]Buhrer M,Mappes A,Lauber R,et al.Dexmedetomidinedecreases thiopental dose requirement and altersdistribution pharmacokinetics[J].Anesthesiology 1994,80(6):1216-1227.
[9]Snapir A,Posti J,Kentala E,et al.Effects of low and highplasma concentrations of dexmedetomidine on myocardialperfusion and cardiac function in healthy male subjects[J].Anesthesiology,2006,105(5):902,1069-1070.
[10]Pekka T,Chen R,Thomas B,et al.The hemodynamic andadrenergic effects of perioperative dexmedetomidineinfusion after vascular surgery[J].Anesth Analg,2000,90(4):834-839.
[11]佘守章,许学兵,李慧玲,等.右旋美托咪啶的镇静效应及其对国人颈内动脉血流量的影响[J].广东医学,2005,26(6):729-732.
[12]Yildiz M,Tavlan A,Tuncer S,et al.Effect ofdexmedetomidine on haemodynamic responses tolaryngoscopy and intubation:perioperative haemodynamicsand anaesthetic requirements[J].Drugs R D,2006,7(1):43-52.
基本信息:
中图分类号:R614
引用信息:
[1]刘晓捷,罗富荣,罗兢聪,等.右美托咪定辅助颈椎手术静脉全麻的临床观察[J].广州医科大学学报,2014,42(04):54-57.
基金信息:
广东省佛山市卫生局医学科研立项(编号:2012148)
2014-08-15
2014-08-15