右美托咪定在黄疸患者全身麻醉中的安全性研究

发布时间：2018-04-21 07:17

本文选题：右美托咪定 + 黄疸　；参考：《重庆医学》2015年29期

【摘要】：目的观察右美托咪定用于黄疸患者全身麻醉的安全性。方法选取肝胆外科需做择期胆道探查手术的梗阻性黄疸患者60例,采用双盲研究随机分为右美组(D组)和对照组(C组),其中D组在麻醉诱导前15min开始以0.5μg/kg负荷量泵注右美托咪定,术中以0.5μg·kg-1·h-1至缝皮前40min结束,C组注入等量生理盐水。记录两组患者的血压、心率、所用麻醉药物剂量、肌肉松弛药总量、麻醉苏醒时间并比较苏醒期并发症的发生率。记录麻醉诱导前未给予右美托咪定或生理盐水时(t1),插管后5min(t2),切皮后10min(t3),拔管后10min(t4)各时点去甲肾上腺素的血浆浓度,记录切皮后10min、停止输注右美托咪定后5min和手术结束时刻的脑电双频指数(BIS)值。结果血流动力学:D组患者术中血压变化幅度明显小于C组患者(P0.05);全身麻醉药使用情况:D组丙泊酚与瑞芬太尼的使用量均小于C组(P0.05);苏醒时间D组患者与C组患者差异均没有统计学意义(P0.05);拔管后患者Ramsay评分:D组患者拔管后1h的Ramsay评分较C组患者拔管后1h的Ramsay评分低(P0.05)。围术期去甲肾上腺素血浆浓度:C组t3和t4时的去甲肾上腺素水平较t1时增高差异有统计学意义(P0.05),而D组以上指标相应时点与t1相比无明显变化;苏醒期并发症:D组寒颤发生率和烦躁发生率较低,但心率变缓的发生率较高(P0.05)。结论右美托咪定可以安全用于梗阻性黄疸患者的全身麻醉中,且可以稳定血流动力学,改善苏醒质量,降低术中患者的血浆去甲肾上腺素浓度。
[Abstract]:Objective to observe the safety of dexmetomidine in general anesthesia in patients with jaundice. Methods A total of 60 patients with obstructive jaundice undergoing elective biliary exploration in hepatobiliary surgery were selected. A double-blind study was carried out. Group C was divided into two groups: group D (group D) and group C (control group). Group D was injected with dexmetomidine with 0.5 渭 g/kg loading pump before anesthesia induction, and group C with 0.5 渭 g kg-1 h-1 to end with 40min before skin suture was injected with the same amount of normal saline during the operation. Blood pressure, heart rate, dosage of anesthetic drugs, total amount of muscle relaxant, anaesthesia recovery time and incidence of complications during anaesthesia were recorded. The plasma concentrations of norepinephrine (norepinephrine) were recorded at 5 min after intubation, 10 min after skin incision, 10 min after extubation and 10 min after extubation. 5min and bispectral index (BIS) at the end of operation were recorded at 10 min after skin incision. Results the change of blood pressure in group D was significantly lower than that in group C (P 0.05), the usage of propofol and remifentanil in group C was lower than that in group C, and the recovery time in group D and group C was lower than that in group C. There was no significant difference between the two groups (P 0.05), and the Ramsay score of group D was lower than that of group C at 1 hour after extubation (P 0.05), and the Ramsay score of group D was lower than that of group C (1 h after extubation). The levels of norepinephrine in group T 3 and T 4 were significantly higher than those in group T1 in perioperative period (P 0.05), but there was no significant difference between group D and group T 1. The incidence of chills and agitation was lower in group D than that in group D, but the incidence of slow heart rate was higher than that in group B (P 0.05). Conclusion dexmetomidine can be safely used in general anesthesia in patients with obstructive jaundice, and can stabilize hemodynamics, improve the quality of recovery and decrease the plasma norepinephrine concentration in patients with obstructive jaundice.
【作者单位】：成都市第一人民医院麻醉科;四川医科大学附属一院疼痛科;
【分类号】：R614

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