【摘要】 目的探讨不同剂量右美托咪定对靶控输注(TCI)丙泊酚辅助镇静效应的影响。方法选择妇科手术患者80例,随机分为对照组(C组)和右美托咪定三组(D1、D2、D3组)。硬膜外麻醉成功后,D1、D2、D3组分别泵注负荷量右美托咪定0.2、0.4、0.6μg.kg-1,泵注时间为10 min,继之按0.2、0.4、0.6μg.kg-1.h-1持续泵注;C组以相同的方法泵注负荷量和持续量的氯化钠注射液。在负荷量之后,四组均同时启动TCI丙泊酚,初始靶浓度为0.5μg.mL-1,根据Ramsay评分(RSS)和BIS值的变化调节丙泊酚靶浓度。观察患者入室时以及BIS分别达85、75、65时的生命体征、RSS及丙泊酚效应室浓度(ce),并记录RSS达5分时的BIS值和丙泊酚ce;记录停止泵注丙泊酚至BIS恢复至≥92时的时间及此时的丙泊酚ce。结果 D1、D2、D3组BIS值为85和75时,RSS低于C组(P<0.05),D2、D3组BIS值为65时RSS低于C组和D1组(P<0.05)。D1、D2、D3组在各时点的丙泊酚ce均显著低于C组(P<0.05),且D2组低于D1,D3组低于D2组(P<0.05)。C、D1、D2、D3组在RSS评分为5分时的BIS值分别为76±7、71±6、65±5、58±4,其中D2、D3组BIS值明显低于C组(P<0.05)。C组和D1组分别发生呼吸抑制7和6例,均高于D2组和D3组(均为1例,P<0.05);D3组发生心动过缓6例,高于其他三组(P<0.05)。结论复合一定剂量的右美托咪定在降低丙泊酚ce的同时可以改善辅助硬膜外麻醉的术中镇静效果,增加丙泊酚辅助镇静安全性。右美托咪定0.4μg.kg-1负荷量后续以0.4μg.kg-1.h-1维持的效果较好。更多还原

【Abstract】 AIM To investigate the influence of different dose dexmedetomidine(Dex) on sedation effect of target controlled infusion(TCI) with propofol for patients undergoing epidural anesthesia.METHODS Eighty female patients scheduled for elective gynecological operation under epidural anesthesia were randomly divided into 4 groups(n = 20 each group) : control group(group C),low-dose Dex group(group D 1),middle-dose Dex group(group D 2),and high-dose Dex group(group D 3).After epidural anesthesia,group D 1,D 2,D 3 received Dex 0.2,0.4,0.6 μg.kg-1 initial loading dose respectively by micro-pump for 10 min and maintaining with 0.2,0.4,0.6 μg.kg-1.h-1 respectively;group C received the equal volume of sodium chloride injection.After the loading dose,all groups received TCI of propofol with target concentration at 0.5 μg.mL-1.The target concentration of propofol was adjusted according to the ramsay score(RSS) and bispectral index(BIS).RESULTS RSS of group D 1,D 2,D 3 were significantly lower than those of group C(P < 0.05) when the BIS to 85 and 75.RSS of group D 2,D 3 were significantly lower than those of group C and D 1(P < 0.05) when the BIS to 65.The effect chamber concentration(c e) of propofol of group D 1,D 2,D 3 were significantly lower than those of group C(P < 0.05),and group D 3 lower than D 1,D 2;group D 2 lower than group D 1(P < 0.05) at each point.The BIS of 4 groups were 76 ± 7,71 ± 6,65 ± 5,58 ± 4 respectively when the RSS reached to 5.The BIS of group D 2 and D 3 were significantly lower than those of group C.Seven patients in the group C and 6 patients in the group D 1 occurred respiratory depression respectively.The incidence of respiratory depression in the group C and group D 1 was significantly higher than that in the group D 2 and D 3(only one patient occurred respiratory depression,P < 0.05).Six patients occurred bradycardia in the group D 3,and the incidence in the group D 3 was significantly higher than those in the other three groups(P < 0.05).CONCLUSION Dex significantly reduces the c e of propofol administrated by TCI under epidural anesthesia for intraoperative sedation,also has less respiratory depression and stable hemodynamic.Dex is a more safety drug and the suitable dose is loading dose 0.4 μg.kg-1 + maintain dose 0.4 μg.kg-1.h-1.更多还原