本文選題：右美托咪定 + 黃疸��； 參考：《重慶醫(yī)學》2015年29期

【摘要】：目的觀察右美托咪定用于黃疸患者全身麻醉的安全性。方法選取肝膽外科需做擇期膽道探查手術的梗阻性黃疸患者60例,采用雙盲研究隨機分為右美組(D組)和對照組(C組),其中D組在麻醉誘導前15min開始以0.5μg/kg負荷量泵注右美托咪定,術中以0.5μg·kg-1·h-1至縫皮前40min結束,C組注入等量生理鹽水。記錄兩組患者的血壓、心率、所用麻醉藥物劑量、肌肉松弛藥總量、麻醉蘇醒時間并比較蘇醒期并發(fā)癥的發(fā)生率。記錄麻醉誘導前未給予右美托咪定或生理鹽水時(t1),插管后5min(t2),切皮后10min(t3),拔管后10min(t4)各時點去甲腎上腺素的血漿濃度,記錄切皮后10min、停止輸注右美托咪定后5min和手術結束時刻的腦電雙頻指數(BIS)值。結果血流動力學:D組患者術中血壓變化幅度明顯小于C組患者(P0.05);全身麻醉藥使用情況:D組丙泊酚與瑞芬太尼的使用量均小于C組(P0.05);蘇醒時間D組患者與C組患者差異均沒有統計學意義(P0.05);拔管后患者Ramsay評分:D組患者拔管后1h的Ramsay評分較C組患者拔管后1h的Ramsay評分低(P0.05)。圍術期去甲腎上腺素血漿濃度:C組t3和t4時的去甲腎上腺素水平較t1時增高差異有統計學意義(P0.05),而D組以上指標相應時點與t1相比無明顯變化;蘇醒期并發(fā)癥:D組寒顫發(fā)生率和煩躁發(fā)生率較低,但心率變緩的發(fā)生率較高(P0.05)。結論右美托咪定可以安全用于梗阻性黃疸患者的全身麻醉中,且可以穩(wěn)定血流動力學,改善蘇醒質量,降低術中患者的血漿去甲腎上腺素濃度。
[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.
【作者單位】： 成都市第一人民醫(yī)院麻醉科;四川醫(yī)科大學附屬一院疼痛科;
【分類號】：R614

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