摘要
目的观察不同剂量右美托咪定(Dex)对氯胺酮复合丙泊酚静脉全麻手术患者麻醉效果及复苏的影响。方法择期行单侧或双侧颈淋巴结结核病灶清除手术患者60例,ASAⅠ~Ⅱ级,随机分成D1组、D2组、D3组,每组20例。3组患者麻醉诱导前10 min均给予Dex负荷剂量1μg/kg,麻醉维持期间D1组患者持续输注Dex0.3μg/(kg·h)至术毕;D2组患者持续输注Dex 0.5μg/(kg·h)至术毕;D3组患者持续输注Dex 0.7μg/(kg·h)至术毕。记录给Dex前(t_1)、诱导前(t_2)、切皮时(t_3)、搔扒病灶时(t_4)、手术结束时(t_5)、术后清醒时(t_6)手术患者的SBP、DBP、HR、Sp O_2及术中不良情况及处理;记录氯胺酮及丙泊酚用量;记录患者手术时间、停药后意识恢复时间、定向力恢复时间及复苏期不良情况,并于患者定向力恢复后1 h(t_7)、2 h(t_8)、4 h(t_9)进行VAS疼痛评分及Ramsay评分,随访术中知晓情况。结果D2组患者HR在t_3、t_4、t_5时间点较t_1时间点有下降(P<0.05);D3组患者SBP、DBP和HR在t_3、t_4、t_5时间点较t_1时间点有下降(P<0.05);组间比较,D3组患者SBP、DBP、HR在t_3、t_4、t_5时间点较D1组和D2组均有下降(P<0.05);D1组、D2组、D3组丙泊酚用量和氯胺酮用量呈递减,差异有统计学意义(P<0.05);D3组患者有2例发生心动过缓,发生率为10%,高于D1组(P<0.05);D2组、D3组患者意识恢复时间、定向力恢复时间均长于D1组患者(P<0.05);术后Ramsay评分中,D3组患者在t_7、t_8、t_9时间点均高于D1组、D2组;在VAS疼痛评分中,D3组患者在t_7、t_8时间点评分低于D1组、D2组患者(P<0.05)。结论3组剂量的Dex持续输注复合氯胺酮、丙泊酚静脉全麻均可完成颈淋巴结结核清除手术的麻醉,低剂量的Dex复合方案(持续输注量为0.3μg/(kg·h))具有更好的循环稳定性,可能更适合此类体表短小手术的麻醉。
Objective To observe the effect of different doses of dexmedetomidin （Dex） on the anesthetic effect and resuscitation of patients undergoing intravenous anesthesia with ketamine combined with propofol. Methods 60 patients with unilateral or bilateral cervical lymph node tuberculosis scavenging operation were selected ASA Ⅰ - Ⅱ grade. They were randomly divided into D2 group D3 group and D3 group with 20 cases in each group. All the patients in the three groups were given Dex loading dose of 1.0 μg/kg 10 minutes before anesthesia induction. During the maintenance of anesthesia, the D1 group was continuously infused with Dex 0.3 μg/（kg · h） to the end of the operation; Patients in group D2 continued to be infusions of Dex 0.5 μg/（ kg · h） to the end of the operation; Patients in group D3 continued to be infusions of Dex 0.7 μg/ （ kg · h） to the end of the operation ; Recorded before administration （ t1 ）, before induction （t2 ）, skin incision （ t3 ）, scratching lesions （ t4 ）, at the end of operation （ t5 ）, postoperative awake （ t6 ） patients, SBP, DBP, HR, SpO2 and adverse conditions and treatment of intraoperative ketamine and recording; The dosage of propofol; records of patients after discontinuation of operation time, consciousness recovery time, orientation recovery time and adverse recovery period, 1 hours and recovery in patients with directional force （t7 ）, 2 hour （ t8 ） , 4 hour （ t9 ） VAS pain score and Ramsay score, known in follow - up. Results The time points of HR at t3, t4 and t5 decreased in group D2 （P 〈 0. 05 ） than at t1 time points （ P 〈 0. 05 ） ; SBP, DBP and HR at t3 , t4, and t5 points in group D3 Were lower than those at t1 time points （P 〈0. 05） ; In group D3, patients with SBP, DBP, and HR decreased in t3, t4, t5 time points than in D1 and D2 （P 〈0. 05）. The dosage of propofol and ketamine decreased in group D1, group D2 and D3, and the difference was statistically significant （P 〈 0. 05 ） ; In
出处
《现代医院》
2018年第2期284-287,共4页
Modern Hospitals
关键词
右美托咪定
颈淋巴结结核
氯胺酮
Dexmedetomidine
Cervical Lymph Node Tuberculosis
Ketamine
