【作者】 刘欢；

【导师】 徐军美；

【作者基本信息】 中南大学 ， 临床医学， 2013， 硕士

【摘要】 目的：探讨不同剂量右美托咪定对丙泊酚靶控输注(TCI)时患者意识消失的有效浓度及BIS值的影响。方法：择期全身麻醉手术患者100例(ASAⅠ～Ⅱ级),随机分成五组(n=20)：右美托咪定Ⅰ组(D1组)、右美托咪定Ⅱ组(D2组)、右美托咪定Ⅲ组(D3组)、右美托咪定Ⅳ组(D4组)和对照组(C组)。D1、D2、D3、D4组麻醉诱导前分别经微量泵泵注右美托咪定0.25μg/kg.0.5μg/kg、0.75μg/kg和1.0μg/kg,10min静脉输注完毕,C组泵注等量生理盐水。麻醉诱导采用丙泊酚TCI,设定起始血浆靶浓度为1.2μg/ml,达到预期血浆靶浓度后每30秒增加0.3μ g/ml,直至患者睫毛反射消失及对口头指令无反应,以此为意识消失的标准,后静脉注射舒芬太尼及顺阿曲库铵,纯氧通气后气管插管。记录患者静脉输注右美托咪定或生理盐水前(TO),静脉输注10min后(T1),患者意识消失时(T2),诱导后插管前(T3),插管后1min(T4)、3min(T5).5min(T6)各时点的MAP、HR。计算并比较D、C组丙泊酚TCI患者意识消失的效应室浓度及BIS值。结果：T2时异丙酚效应室靶浓度,D1、D2、D3、D4组明显低于C组(P<0.01),随着右美托咪定用药剂量增高异丙酚效应室浓度逐渐下降；T2时D2、D3、D4组患者BIS值高于C组(P<0.05)；C组患者MAP,HR较插管前明显升高,T4时点D组患者的MAP、HR均低于C组(P<0.05)。结论：随着右美托咪定剂量增加丙泊酚意识消失的有效浓度下降；合用右美托咪定异丙酚靶控输注意识消失时的BIS值较单独异丙酚靶控输注时高；右美托咪定可有效抑制气管插管的心血管反应。更多还原

【Abstract】 Objective To evaluate the effect of the different dose of dexmedetomidine on the effective concentration and the BIS of propofol target-controlled infusion (TCI) for unconsciousness.Methods One hundred patients(ASA Ⅰ～Ⅱ) scheduled for elective operation under general anesthesia were enrolled in this study. All patients were randomly divided into five groups(n=20):dexmedetomidine group Ⅰ (group D1), dexmedetomidine group Ⅱ (group D2), dexmedetomidine group Ⅲ(group D3), dexmedetomidine group IV (group D4) and control group (group C). In group D1, group D2, group D3and group D4,0.25μg/kg,0.5μg/kg,0.75μg/kg and1.0μg/kg of the doses dexmedetomidine was administered intravenously by micro pump respectively for over10minutes before general anesthetic induction, while in group C, same volume of0.9%normal saline was given by the same way. Propofol was used to anesthetic induction by targetcontrolled infusion (TCI),1.2μg/ml was set as start target plasma concentration, then0.3μg/ml was increased every30seconds until the patients eyelashreflex disappearing and doing no respond to verbal instructions. Sulfentanil and Cis-atracurium were administered intravenously, and pure oxygen was inhaled before endotracheal intubation was enforced. The parameters of MAP and HR were recorded before dexmedetomidine or0.9%normal saline infused intravenously (TO),10min after intravenous infusion (T1), the time that patients eyelashreflex disappeared and did no respond to verbal instructions (T2), preintubation(T3),1min after intubation (T4),3min after intubation(T5),5min(T6) after intubation. The target effect-site concentration and BIS of propofol for unconsciousness in group Dl, D2, D3, D4and C was computed and compared.Results At T2, The target effect-site concentration of propofol for unconsciousness in group D1, D2, D3and D4was lower than in group C (P<0.01). BIS in group D2, D3and D4was lower than in group C (P<0.05). In group C, HR and MAP after the intubation was significantly greater than before (P<0.05), however, in group D showed no change (P>0.05); HR and MAP in group D was lower than in group C at T4(P <0.05).Conclusion With the increase of the dose of dexmedetomidine, the effective concentration of propofol at loss of consciousness decreased and the BIS is higer at loss of consciousness than without dexmedetomidine; Dexmedetomidine reduces the response of endotracheal intubation.更多还原