摘要
目的比较不同剂量右美托咪定对丙泊酚全麻诱导期间患者脑电双频指数（BIS）值及血流动力学的影响。方法选择ASAI～Ⅱ级择期全麻手术患者50例，随机分为5组，每组10例。D1～D4组和C组（对照组）于麻醉诱导前10min内分别泵注右美托咪定0．25、0．50、0．75、1．0μg·kg^-1和氯化钠注射液。给药后每3min行警觉一镇静（OAA／S）评分一次，并记录BIS值。丙泊酚靶控输注（TCI）麻醉诱导，初始靶浓度设定为0．5μg·mL^-1，根据OAA／S评分和BIS值调整靶浓度，每次增加0．5μg·mL^-1，直到患者OAA／S评分达1分。记录给药前（T0），给药后3min（TI）、6min（T2）、9min（T3），OAA／S评分1分时（T4），插管前（T5），插管后1min（T6）、插管后3min（T7）各时刻的BIS值、心率（HR）、平均动脉压（MAP）值。记录T4时丙泊酚效应室浓度（Ce），观察各组不良反应发生情况。结果给予右美托咪定负荷剂量后，D2组、D3组、D4组患者BIS逐渐下降；丙泊酚TCI后，各组患者BIS均显著下降（P〈0．05）；C组、D1组插管后BIS值较T5时明显升高（P〈0．05）。与T0时比较，C组、D，组HR、MAP在T6、T7时显著升高（P〈0．05）；D2组HR、MAP在T2～T5时降低（P〈0．05）；D3组、D4组HR在T1～T5时均降低（P〈0．05）．MAP在T1～T3时显著升高（P〈0．05）。T4时各组丙泊酚Ce随着右美托咪定负荷剂量增加逐渐下降并呈线性相关（r=0．893，P〈0．05）。各组均无严重不良反应发生，麻醉诱导期间D1组、D2组、D3组、D4组分别发生心动过缓2、1、2、4例。结论右美托咪定负荷剂量0．50μg·kg^-1静脉泵注，可降低诱导期间患者的BIS值，增强丙泊酚镇静效应，患者血流动力学稳定。
AIM To compare the different doses of dexmedetomidine on bispectral index （BIS） values and hemodynamic parameters in patients during induction of general anesthesia with propofol. METHODS Fifty ASA I -Ⅱ level patients undergoing elective surgery were randomly divided into five groups （n = 10） . The patients in the control group （group C） and group D1- D4 were given sodium chloride injection and dexmedetomidine 0.25, 0.50, 0.75, 1.00 μg· kg^-1 before anesthesia induction. The alert- sedation （OAA/S） score and BIS value were observed every 3 min after administration. All patients received target- controlled infusion of propofol. The initial target concentration was 0.5 μg·mL^-1, and adjusted by 0.5 μg· mL^-1 each time according to OAA/S score and BIS, until OAA/S score reached 1 point. In each group, BIS value, heart rate （HR）, and mean arterial pressure （MAP） were monitored at pre-induction （T0） ; 3 min （T1）, 6 min （T2）, 9 min （T3） after the treatment; OAA/S reached 1 point （T4）; before intubation （T5）, and 1 min （T6）, 3 min （T7） after intubation. The concentration of propofol effect chamber （Ce） was recorded at T4 and adverse reactions were observed. RESULTS After dexmedetomidine loading dose were given, the BIS value gradually declined in the groups D2, D3 and D4. The BIS value were significantly decreased since induction beginning in each group （P 〈 0.05） . Compared with that at T5, the BIS value was significantly higher in the group C and D1 （P 〈 0.05） . Compared with those at To, HR and MAP at T5 - T6 increased significantly in the group C and D1 （P 〈 0.05） ; HR and MAP at T2 - T5 were decreased in the groups D2 （P 〈 0.05） ; HR at T1 -T5 were decreased in the group D3 and D4 （P 〈 0.05） and the MAP at T1 - T3 was significantly increased （P 〈 0.05） . The co of propofol gradually decreased linearly correlated with the load dosage of dexmedetomidine （r = 0.893, P 〈 0.05）. No serious adverse reaction occur
出处
《中国新药与临床杂志》
CAS
CSCD
北大核心
2014年第11期799-803,共5页
Chinese Journal of New Drugs and Clinical Remedies
基金
广东省科技计划项目(2012B031800417)
