国际麻醉学与复苏杂志   2013, Issue (9): 6-6
    
右美托咪定不同给药方法用于腹腔镜胆囊切除术患者麻醉中的临床观察
郎宇, 王天龙, 肖娜1()
1.首都医科大学宣武医院
Clinical obseration on sedation with dexmedetomidine of different administration methods during General anesthesia in the Laparoscopic cholecystectomys
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摘要:

目的: 探讨右美托咪定(DEX)不同给药方法在腹腔镜胆囊切除术(LC)患者麻醉中辅助镇静的安全性和可行性。方法: 100例LC患者按随机数字表法分为四组:DEX负荷剂量组(Dd组) 、持续剂量组(Dc组) 、负荷剂量加持续输注剂量组(Ddc组) 、对照组(C组),每组25例。通过不同的给药方法观察DEX对围术期循环、呼吸指标,及苏醒和术后镇痛的影响。结果:Dd组、Dc组患者在清醒时间及拔管时间较C组、Ddc组明显缩短(P<0.05);应用DEX的三组术后2hrVAS评分明显低于C组(P<0.05); Dd组、Dc组和Ddc组在应用DEX后血压和心率明显降低(P<0.05),与C组比较也明显下降(P<0.05),但四组患者围术期循环参数均在正常范围内; Dd组、Dc组和Ddc组在麻醉维持中应用的镇痛、镇静药物的总量与C组比较明显减少(P<0.05)。结论: 应用负荷剂量、持续剂量及负荷剂量加持续剂量输注的DEX均可用于LC麻醉中的辅助镇静,既稳定循环、又苏醒迅速,负荷剂量及持续剂量输注的方法更优于负荷加持续输注的方法,但仍需大样本研究加以证实。

关键词: 腹腔镜胆囊切除术;右美托咪定;镇静;全麻
Abstract:

Objective: To investigate the feasibility and safety of sedation with dexmedetomidine(DEX) in different methods during general anesthesia in the Laparoscopic cholecystectomy(LC). Method: 100 LC patients were randomly divided into the four groups, group Dd (loading dose), group Dc (continuous infusion), group Ddc (loading dose plus continuous infusing), and group C (control). To observe the affect of DEX in circulation indicators, respiratory indicators, awaking and postoperative analgesia through different administration methods of DEX. Results: The awake time and extubation time in group Dd and Dc were obviously shorter (P<0.05) compared with group C and Ddc. the scores of VAS in the three DEX groups was obviously lower(P<0.05)compared with group C. Blood pressure and HR were significantly lower in group Dd, Dc and Ddc after administration of DEX,(P<0.05),They were also significantly decreased(P<0.05)compared with group C, but all hemodynamic parameters in 4 groups were in normal range during operation.. The total amout of analgesia and sedative anesthetics were obvious lower in group Dd, Dc and Ddc compare with group C during anesthesia maintainance(P<0.05). Conclusion: Application DEX with methods of loading dose, continuous infusion and loading plus continuous infusion may all be used as sedation during general anesthesia in LC, The circulation is stable and patients wake up quickly. The methods of loading dose and continuous infusion are better than continuous infusion after the loading dose. But still need a large-sample study confirmed.

Key words: Dexmedetomidine; Elderly; Sedation; Intrathecal anesthesia