尹亚岚,马跃成,陈亮,张贵翠,王军
YIN Yalan,MA Yuecheng,CHEN Liang,ZHANG Guicui,WANG Jun

• 1:攀钢集团总医院麻醉科
• 2:南京医科大学附属无锡人民医院麻醉科

摘要(Abstract)：

目的:观察右美托咪定全麻维持在高龄患者腹腔镜胆囊切除术中的效果。方法:96例行腹腔镜胆囊切除术的高龄患者,根据维持全麻用药均分为丙泊酚组和右美托咪定组;记录两组患者插入喉罩时点(T_1)、手术开始进镜时点(T_2)、游离胆囊时点(T_3)、撤镜时点(T_4)、拔出喉罩时点(T_5)的心率(HR)、收缩压(SBP)、舒张压(DBP)、脑电双频指数(BIS);比较两组患者术毕苏醒时间、拔喉罩时的苏醒评分及改良OAA/S评级。结果:右美托咪定组患者T_1~T_5各时间点的HR、SBP及DBP明显低于丙泊酚组,差异具有统计学意义(P<0.05);丙泊酚组的HR、SBP和DBP水平在T_1~T_5间的波动明显,各时间点比较差异有统计学意义(P<0.05);而右美托咪定组的HR、SBP和DBP水平在T_1~T_4时点分别比较,差异无统计学意义(P>0.05),T_5时间点明显高于T_1~T_4时点(P<0.05)。两组患者各时点的BIS值比较,差异无统计学意义(P>0.05),组内与T_1时点BIS值比较,T_2时点虽有所下降但差异无统计学意义(P>0.05),T_2~T_5时间内均逐渐上升,两两比较差异有统计学意义(P<0.05);两组患者的术毕苏醒时间、拔喉罩时的苏醒评分及改良OAA/S评级比较,差异无统计学意义(P>0.05)。结论 :右美托咪定全麻维持在高龄患者腹腔镜胆囊切除术中的效果显著优于丙泊酚,可明显改善患者血流动力学指标。
Objective: To observe the efficacy of dexmedetomidine in the use of general anesthesia maintenace in laparoscopic cholecystectomy in elderly patients. Methods: 96 elderly patients undergoing laparoscopic cholecystectomy were divided into propofol group and dexmedetomidine group. Heart rate( HR),systolic blood pressure( SBP),diastolic blood pressure( DBP),bispectral index( BIS)of two patients were recorded at laryngeal mask insertion time( T_1),the operation beginning and placing laparoscopy time( T_2),free gallbladder time(T_3),laparoscopy withdrawal time(T_4) and laryngeal mask extubation time( T_5); postoperative reviving time,the reviving score when laryngeal mask extubation and improved OAA/S rating were compared between the two groups. Results: HR,SBP and DBP at T_1~ T_5 in Dexmedetomidine patients was significantly lower than the propofol group,the difference was statistically significant( P < 0. 05); the changes of HR,SBP and DBP at T_1~ T_5 in propofol group between the obvious,there was statistical difference between each time points( P <0. 05),while HR,SBP and DBP levels at T_1~ T_4 in dexmedetomidine group were not statistically different( P > 0. 05); the indexes in dexmedetomidine group at T_5 was significantly higher than that of T_1~ T_4(P < 0. 05). No statistically significant difference of BIS value at each time point was found between the two groups( P > 0. 05); and compared with the value of BIS at T_1 in each group,BIS value at T_2 was decreased,but the difference was not statistically significant( P > 0. 05),BIS value from T_2 to T_5gradually increased with significant difference( P < 0. 05); the differences of postoperative reviving time,the reviving score when laryngeal mask extubation and improved OAA/S rating were not statistically significant( P > 0. 05). Conclusion: The efficacy of dexmedetomidine in the use of general anesthesia maintenace in laparoscopic cholecystectomy in elderly patients is beter than propofol and can Can significantly improve the hemodynamic parameters of patients.

关键词(KeyWords)： 丙泊酚;右美托咪定;胆囊切除术;全麻维持;效果;高龄
propofol;dexmedetomidine;cholecystectomy;general anesthesia maintenace;effect;elderly

Abstract:

Keywords:

基金项目(Foundation): 南京医科大学科技发展基金项目(08NMUM095)

作者(Author): 尹亚岚,马跃成,陈亮,张贵翠,王军
YIN Yalan,MA Yuecheng,CHEN Liang,ZHANG Guicui,WANG Jun

DOI: 10.19367/j.cnki.1000-2707.2017.01.027

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