摘要
目的探讨右美托咪定复合瑞芬太尼+丙泊酚泵注在术中行神经电生理监测的甲状腺手术的临床应用和效果。方法择期行术中神经电生理监测(IONM)的甲状腺手术患者72例,随机均分为右美托咪定组(D)和对照组(C),D组诱导前10min静脉泵注右美托咪定0.6μg/kg预给量,随后持续泵注0.4μg·kg^(-1)·h^(-1)至手术结束前30min结束,C组给予等量生理盐水。两组均采用咪达唑仑0.05mg/kg、异丙酚2mg/kg、芬太尼0.04mg/kg、罗库溴铵0.3mg/kg快速诱导,插入神经监测专用导管。术中瑞芬太尼+丙泊酚泵注维持麻醉,不用肌松药。记录不同时间点两组病人的BIS,MAP,HR;记录丙泊酚和瑞芬太尼的用量、麻醉恢复情况、术后舒适度和术中知晓情况;记录术中神经监测四步法:V_1,R_1,R_2,V_2数值。结果 D组T_1时BIS值明显低于T_0和C组(P<0.01);D组T_1~T_5 MAP低于、HR慢于C组(P<0.05或P<0.01);D组术中神经监测V_1,R_1,R_2,V_2略高于C组(P>0.05),无统计学意义;D组丙泊酚和瑞芬太尼用量明显少于C组(P<0.05);D组苏醒期间烦躁明显低于C组(P<0.01),术后4h舒适度BCS明显优于C组(P<0.01)。两组随访都无术后知晓,无喉返神经损伤。结论右美托咪定复合瑞芬太尼+丙泊酚泵注全麻,对甲状腺手术IONM无影响,能满足手术要求,并具有麻醉药的用量少,术中血流动力学平稳,术后不良反应少等优点。
Objective To investigate the clinical use of dexmetomidine combined with remifentanil and propofol for thyroidecto -my under intraoperative intraoperative neuromonitoring .Methods Seventy-two thyroidectomy patients were randomly divided into 2 groups：group（D） used dexmedetomidine,group（C/the control group）.Ten minutes before induction of general anesthesia ,intravenous infusing dexmedetomidine（0.6μg/kg） was given and constant intravenous infusing dexmedetomidine （0.4μg＆#183; kg-1 ＆#183; h-1 ） was applied to maintain anesthesia till 30 minutes before operation end .Group C was applied with 0.9%sodium chloride solution of the same quantity .The two groups used rocuronium（0.3mg/kg） as muscle relaxants for anesthesia induction .During operation,remifentanil and propofol were applied constantly without muscle relaxants .BIS,MAP,HR of different time ,dose of propofol and remifentanil ,anesthesia relieve ,adverse events after operation , value of V1,V2,R1,R2 from electrophysiology monitor were all recorded .Results The BIS value at T1 was under T0,as Group D under Group C（P〈0.01）;MAP and HR of Group D from T1 to T5 was either less or slower than Group C correspondingly （P〈0.05 or P〈0.01）. Larger V1,V2,R1,R2 were recorded for Group D（P〉0.05）.A smaller dose of propofol and remifentanil was used for Group D and group D had relatively less incidence of agitation ,better comfort score（BCS ratings） four hours after operation than group C （P〈0.01）.No anesthesia awareness happened .Conclusion Dexmedetomidine combined with remifentanil and propofol applied for general anesthesia intravenously needs a smaller dose of drug ,has the advantages of stable hemodynamics and less adverse events without obviously influence for intraoperative neuromonitoring .
出处
《潍坊医学院学报》
2015年第4期315-317,320,共4页
Acta Academiae Medicinae Weifang
