Objective To investigate the effect of dexmedetomidine on agitation after etomidate-remifentanil anesthesiabefore end of surgery.MethodsChose 100 patients who under general anesthesia laparoscopic operation, ASA I~II, randomly divided them into dexmedetomidine group(group D, 50 cases) and control group(group C, 50 cases), routine anesthesia induction, after tracheal intubation, breath control, maintenance of anesthesia: etomidate target controlled effect compartment (Arden Model) concentration of 0.3μg/ml, remifentanil 0.20~0.4μg/(kg·min) continuous infusion, vecuronium to maintain muscle relaxation. Operation before the end of 30 min after intravenous analgesia pump. Two groups of patients in operation before the end of the 10min stop drug input, using intravenous injection pump intravenous injection of physiological saline (group C) and dexmedetomidine 0.5μ g/kg, injection time of 10min. Compared with two groups of awakening, extubation time, extubation agitation of patients with HR, to observe the change of situation; SBP, DBP, RR. Analysis of data using SPSS 13 statistical softwar.ResultsSedation and agitation conditions compared with T0 group, Ramsay score decreased at T2, T4, T5 in group C(P<0.05); group D, T2, T4~T6 Ramsay score increased significantly (P<0.01), and higher than that of group C (P<0.01). Group D agitation score was significantly lower than group C (P<0.01).ConclusionIntravenous dexmedetomidine 0.5μg/kg before end of surgery can significantly reduce agitation etomidate intravenous anesthesia recovery period, stable hemodynamics without extending extubation time.

目的观察和分析右美托咪定持续输注对心脏手术麻醉患者血液动力学的影响。方法选取60例行心内直视手术麻醉的患者作为研究对象,将其随机分为观察组和对照组,每组各30例。用咪达唑仑、芬太尼、维库溴铵进行麻醉诱导后,观察组用芬太尼和右美托咪定进行维持麻醉,对照组用芬太尼和咪达唑仑进行维持麻醉。必要时均以异氟醚吸入维持麻醉。对两组患者在诱导前(T1)、麻醉后1h(T2)、切皮前(T3)、切皮时(T4)、手术结束时(T5)、手术结束后10 min(T6)等时点的心率和血压情况进行监测,同时记录异氟醚的使用情况和患者出现的不良反应情况。结果两组间(处理因素)差异和各组内(测量时间)差异均具有统计学意义(P<0.05),且处理因素与测量时间交互作用比较,差异有统计学意义(P<0.05);两组患者的收缩压和心率于麻醉1 h后和切皮前显著下降(P<0.05),在切皮时,对照组的收缩压、舒张压和心率较切皮前显著升高(P<0.05),且明显高于观察组(P<0.05);观察组患者中有10例需加用异氟醚维持血液动力学指标的稳定,而对照组患者中有26例需加用异氟醚,观察组的使用比例显著低于对照组(P<0.05),观察组和对照组患者发生心动过缓的比例分别为10%和13.3%,两组之间的差异无统计学意义(P>0.05),两组发生低血压的比例均为16.7%,两组均未见严重的不良反应出现。结论在心脏手术麻醉中应用右美托咪定持续输注可对患者产生较好的抗交感和镇静作用、稳定血液动力学指标、保护心脏功能,且安全性较高,值得在临床上推广应用。

Objective: To investigate the feasibility of Etomidate emulsions combined with Remifentanil on elderly patients during total intravenous anesthesia(TIVA.) Methods: One hundred elderly patients above sixty with ASA I~II who underwent abdominal surgery were randomly divided into Etomidate group(E,n=50)and Propofol group(P,n=50).In the two groups,all the patients received the same anesthesia induction.The patients in group E were given Etomidate 10~15 μg/(kg.min)formaintenance dose,and those in group P,Propofol6~10 mg/(kg.h)as the controls.Remifentanil was combined during the surgery in both groups.There were observed and recorded for cardiovascular effects,blood plsma cortisol changes and postoperative analepsia condition before anesthesia,5 min and 30 min after incising the skin,0 h,2 h and 24 h after operation.Results: The stable hemodynamics in both groups could be maintained perioperatively,but the fluctuation was significantly lower in group E than those in group P.The content of blood plasma cortisol in both groups alldecreased with in normal limits among intraoperative and postoperative time points.Compared with group P,the content of cortisol was lower in group E(P0.05),though the cortisol in both groups alldecreased obviously at operation end.The cortisol recovered to the preoperative level 24 h after operation.Recovery time after operation of group P was shorter than that of group E(P0.05).Con-clusion: Etomidate emulsions is more suitable for elderly patients during the maintenance of genenal anesthesia with less cardiovascular effects than Propofol.It is safe to use Etomidate on elderlypatients without adrenal cortex hypofunction during TIVA as the inhibitory action of Etomidate on adrenal cortex is short-lived.

近年来腹腔镜技术在妇科、普外科手术中的应用,对腹腔镜麻醉管理提出了新的理念思考.麻醉选择以快速、短效,能解除人工气腹不适、避免CO2气腹性生理变化为原则,同时要求一定的麻醉深度.