| 引用本文： |
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任玲,周依露,王清秀.右美托咪定在腹腔镜下保胆手术中的应用[J].同济大学学报（医学版）,2017,38(5):63-68. [点击复制]
- REN Ling,ZHOU Yi-Lu,WANG Qing-xiu.Application of dexmedetomidine in laparoscopic gallbladder surgery[J].同济大学学报（医学版）,2017,38(5):63-68. [点击复制]
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| 摘要: |
| 目的 观察右美托咪定在腹腔镜下保胆手术中控制性降压作用的应用效果和安全。方法选取90例行择期腹腔镜下保胆取石术患者，随机分为右美托咪定1组(E1组)、右美托咪定2组（E2组）、和对照组（生理盐水组），每组30例。以丙泊酚、瑞芬太尼靶控输注和罗库溴铵静注行麻醉诱导，以丙泊酚、瑞芬太尼靶控输注麻醉中维持。3组患者麻醉诱导前10min分别给予右美托咪定1.0、0.5μg/kg和同等剂量的生理盐水，维持MAP为（65±5）mmHg，如不能达到此目标，予硝酸甘油0.25mg单次静脉注射。记录患者在安静状态下（T0）、药物负荷量后(T1)、气管插管即刻(T2)、手术开始即刻(T3)、手术开始后5min(T4)、手术开始后10min(T5)、手术开始后15min(T6)、停止用药时(T7)、停药后5min（T8）、停药后10min(T9)、拔除气管导管即刻(T10)、拔除气管导管后5min（T11)时MAP、HR、BIS，记录丙泊酚、盐酸瑞芬太尼、血管活性药物用量及手术时间、麻醉苏醒时间，观察进入PACU时Ramsay镇静评分、术后VAS疼痛评分及术后恶心、呕吐等不良反应的发生情况。结果E1、E2组MAP均能维持在目标范围，对照组需静注硝酸甘油。E1、E2组麻醉药物诱导剂量明显低于对照组（P<0.05），E1、E2组差异无统计学意义（P>0.05）。3组患者麻醉清醒时间、Ramsay评分、术后VAS疼痛评分差异无统计学意义（P>0.05），对照组术后PONV发生率高于E1、E2组，但差异无统计学意义（P>0.05）。结论右美托咪定在腹腔镜下保胆手术中应用时，控制性降压作用效果确切，血液动力学稳定，临床应用安全 |
| 关键词: 右美托咪定 保胆手术 控制性降压 |
| DOI：10.16118/j.1008-0392.2017.05.013 |
| 投稿时间：2017-02-10 |
| 基金项目:上海市浦东新区科委科技发展创新基金（PKJ2011-Y37）；上海市卫生局科研基金项目(2011257) |
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| Application of dexmedetomidine in laparoscopic gallbladder surgery |
| REN Ling,ZHOU Yi-Lu,WANG Qing-xiu |
| (Dept. of Anesthesiology, East Hospital, Tongji University, Shanghai 200120, China) |
| Abstract: |
| Objective To evaluate the efficacy and safety of dexmedetomidine for controlled hypotension in laparoscopic gallbladder surgery. MethodsNinety patients undergoing laparoscopic cholecystolithotomy were randomly divided into dexmedetomidine group 1 (Group E1) and dexmedetomidine group 2 (Group E2) and control group with 30 cases in each group. Target controlled infusion（TCI）of propofol and remifentanil，and intravenous injection of rocuronium for anesthesia induction，Maintenance anesthesia with propofol and remifentanil by TCI. Before anesthesia induction，the patients were given intravenous 1, 0.5μg/kg of dexmedetomidine or the same volume of saline for 10min in three groups, respectively. The target of controlled hypotension was （65±5）mmHg， If it cannot be achieved, a single dose of 0.25mg nitroglycerin was intravenously injected. The mean arterial blood pressure (MAP) and heart rate (HR) were recorded at a quiet state (T0)， drug loading (T1)， tracheal intubation (T2)， the beginning of surgery (T3), 5min (T4)， 10min (T5) and 15min (T6) after operation，and the withdrawal time (T7), 5min (T8)，10min (T9) after withdraw, tracheal extubation (T10) and 5min after extubation (T11). The dose of propofol and remifentanil, the dosage of vasoactive drugs, operation time and recovery time, observed Ramsay sedation score, postoperative VAS pain score, postoperative nausea, vomiting and other postoperative adverse reaction were also documented. ResultsThe goals of the MAP in group E1 and group E2 were achieved, and nitroglycerin injection was required in control group. The amount of induction anesthetic drugs in groups E1 and E2 were significantly lower than those in control group (P<0.05)，while there was no significant difference between groups E1 and E2 (P>0.05). There were no significant differences in the recovery time, Ramsay score and postoperative VAS pain score among three groups. The incidence of post operation nausea and vomiting (PONV) in control group was higher than that in groups E1 and E2. ConclusionAdministration of dexmedetomidine for adjuvant controlled hypotension in laparoscopic gallbladder surgery under general anesthesia is effective and safe with hemodynamic stability. |
| Key words: dexmedetomidine laparoscopic gallbladder surgery controlled hypotension |
