不同剂量右美托咪定对丙泊酚–芬太尼复合用于宫颈锥切术麻醉效果的影响

Influence of Different Doses of Dexmedetomidine on the Anesthesia Effect of Propofol-Fentanyl Combined in Cervical Conization

摘要: 目的：比较复合不同剂量右美托咪定在宫颈锥切术中对患者呼吸、循环及恢复时间的影响。方法：选择择期拟行宫颈锥切术的患者90例，ASA I~II级，年龄18~60岁，体重45~75 kg，BMI 18~28 kg∙m⁻²。按照随机数字表法将患者分为3组，每组30例。D1组、D2组和D3组分别于患者入室后静脉输注右美托咪定0.3、0.6、0.9 μg∙kg⁻¹，泵注时间10 min。随后靶控输注丙泊酚(起始靶浓度1.5 μg∙mL⁻¹)和静注芬太尼0.5 μg∙kg⁻¹复合麻醉。观察并记录各时间点的心率(HR)、平均动脉压(MAP)、呼吸频率(RR)、呼吸末二氧化碳(P_ETCO₂)、丙泊酚效应室浓度(Ce)。记录丙泊酚及芬太尼用量，苏醒时间，恢复时间，不良反应，术后调查术者及患者的满意度。结果：由于影响手术操作，D1组3例患者使用了神级肌肉阻滞剂，排除在研究之外。与D1组相比，D2组患者术中P_ETCO₂和RR均无显著降低，呼吸维持稳定，MAP无显著降低，血流动力学稳定(P < 0.05)。与D3组相比，D2组患者HR无显著降低，血流动力学稳定(P < 0.05)。D1组舌后坠的发生率为51.9%，呼吸暂停发生率为18.5%，血压降低发生率为25.9%，D3组心动过缓发生率为73.3%，与D2组差异显著(P < 0.05)。与D1组相比，D2及D3组丙泊酚和芬太尼用量减少(P < 0.05)。三组患者苏醒时间无显著差异(P > 0.05)，D2、D3组恢复时间更短(P < 0.05)。三组手术时间、患者及术者的满意度无显著差异(P > 0.05)。结论：与0.3 μg∙kg⁻¹和0.9 μg∙kg⁻¹的右美托咪定相比，0.6 μg∙kg⁻¹右美托咪定减少了全麻药物的用量，提供了更稳定的呼吸和血流动力学特征，离室和恢复时间更短。

Abstract: Objective: To evaluate the effects of different doses of dexmedetomidine on respiration, circulation and recovery time during anesthesia in patients undergoing cervical conization. Methods: Ninety patients, ASA physical status I~II, aged 18~60 years, weighing 45~75 kg, BMI 18~28 kg∙m⁻², undergoing cervical conization, were randomly divided into groups 0.3 μg∙kg⁻¹ (D1), 0.6 μg∙kg⁻¹ (D2), 0.9 μg∙kg⁻¹ (D3) using a random number table by nurse anesthetist (not participating in observation). Blind method was used in this study. Dexmedetomidine 0.3, 0.6, 0.9 μg∙kg⁻¹ were infused intravenously for 10 min before the patients are quiet in groups D1, D2, D3, respectively. And then TCI propofol (the target plasma concentration was set at 1.5 μg∙mL⁻¹) and fentanyl 0.5 μg∙kg⁻¹ were given. The assessment of HR, MAP, RR, P_ETCO₂, Ce were continuously monitored. Dose of propofol and fentanyl, awakening time, recovery time, the incidence of adverse reaction were also recorded. Satisfaction of surgeons and patients were investigated after surgery. Results: Eighty-seven patients were enrolled, and three patients in group D1 were excluded from the study because of neuromuscular blocking agent use. P_ETCO₂, RR, MAP were not significantly lower in group D2 than in group D1, and respiratory was stable (P < 0.05). HR was not significantly lower in group D2 than in group D3, and the patients were hemodynamically stable (P < 0.05). The rate of glossocoma, apnea and hypotension is 51.9%, 18.5%, 25.9% respectively in group D1, the rate of bradycardia is 93.3% in group D3; there was significant difference with group D2 (P < 0.05). Dose of propofol and fentanyl decreased in group D2 and D3 compared with group D1 (P < 0.05). There was no significant difference in operative time, and the satisfaction rate of both patients and operators between the three groups (P > 0.05). Conclusion: Compared with 0.3 and 0.9 μg·kg⁻¹, dexmedetomidine, 0.6 μg·kg⁻¹ intravenous infusion reduced dosage of general anesthetic drugs, better kept the stability of respiration and circulation, and shortened the recovery time.