右美托咪定复合靶控输注丙泊酚和瑞芬太尼对脑瘫双下肢矫形手术安全性及有效性观察

目的：观察预先给予不同剂量右美托咪定对靶控输注丙泊酚和瑞芬太尼全麻在脑瘫双下肢矫形手术中的安全性及有效性。以丙泊酚、瑞芬太尼靶控输注（TCI）为基础的全凭静脉麻醉，全程复合使用右旋美托咪定，探讨其对丙泊酚用量、术后拔管时间、睁眼时间和复苏期血流动力学变化等指标的影响。方法：择期全麻下行脑瘫双下肢矫形手术患者60例，随机分成3组（n=20）：对照组C、实验组D1、实验组D2。D1组患者于15 min内输注0.25μg·kg-1右旋美托咪定，随即以0.25μg·kg-1·h-1输注右旋美托咪定至拔管；D2组患者于15 min内输注0.45μg·kg-1右旋美托咪定，随即以0.45μg·kg-1·h-1输注右旋美托咪定至拔管；C组同法输注生理盐水。右旋美托咪定负荷剂量完成后开始丙泊酚TCI输注麻醉诱导血浆靶浓度3μg·mL-1，瑞芬太尼TCI血浆靶浓度3.5 ng·mL-1，静脉给予维库溴铵0.1 mg·kg-1、全凭静脉麻醉维持。记录观察注药前（T0）、麻醉诱导前（T1）、插管前即刻（T2）、插管后即刻（T3）、插管后3 min （T4）、拔管后即刻（T5）、拔管后3 min（T6）的脑电双频指数（BIS）、平均动脉压（MAP）、心率（HR）；丙泊酚和瑞芬太尼的用量、麻醉恢复情况，随访术后延迟性呼吸抑制、术中知晓情况。术中丙泊酚、瑞芬太尼用量，气管拔管时间、睁眼时间、术中和麻醉期不良反应的发生情况。结果：三组瑞芬太尼用量、气管拔管时间无统计学意义（P＞0.05）。与对照组相比，D1组、D2组苏醒时间延长，术中高血压、心动过速和麻醉恢复期高血压、心动过速、烦躁、呕吐和寒战发生率降低（P＜0.05）。与D1组相比，D2组丙泊酚用量减少，苏醒时间延长，术中高血压、心动过速和麻醉恢复期高血压、心动过速、烦躁、呕吐和寒战发生率降低（P＜0.05）。 T2时D2组BIS明显低于T1时和C组（P＜0

Efficacy of Anesthesia with Different Doses of Dexmedetomidine Combined with Propofol and Remifentanil in Cerebral Palsy Patients Undergoing Lower Limb Orthopedic Surgery

To evaluate the efficacy of anesthesia with different doses of dexmedetomidine combined with propofol and remifentanil in cerebral palsy patients undergoing lower limb orthopedic surgery. Methods： Sixty ASA Ⅰor Ⅱpatients of both sexes, aged 16~45 yr, weighing 37~70 kg and un-dergoing cerebral palsy lower limb orthopedic surgery, were randomly assigned into 3 groups （n=20 each）：control group （group C）, dexmedetomidine 0.25μg·kg-1·h-1 group （group D1） and dexmedetomidine 0.45μg· kg-1·h-1 group （group D2）. Dexmedetomidine was infused at a rate of 0.25μg·kg-1·h-1 and 0.45μg·kg-1·h-1 in group D1 and group D2, respectively, until extubation after a loading dose of 0.25μg·kg-1 over 15 min. In group C, normal saline was infused intravenously at a rate of 10 mL·h-1. Anesthesia was induced with TCI of propofol with the target plasma concentration （Cp） of 3μg·mL-1, iv injection of vecuronium 0.1 mg· kg-1 and TCI of remifentanil with Cp of 3.5 ng·mL-1. The patients were tracheal intubated and mechanically ventilated. PETCO2 was maintained 35~45 mmHg and SpO2 was maintained ≥95%. The amount of remifen-tanil, vecuronium and propofol consumed, extubation time and eye-opening time, compilcations during oper-ation and during recovery from anesthesia were recorded. Result： There was no significant difference in the amount of remifentanil and vecuronium consumed and extubation time among the 3 groups （P〉0.05）. Com-pared with group C, the eye-opening time was significantly prolonged, the incidence of hypertension and tachycardia during operation, and restlessness, vomitting, hypertension and tachycardia during recovery from anesthesia was significantly decreased in group D1 and D2, the amount of propofol consumed was signifi-cantly decreased in group D2 （P〈0.05）. Compared with group D1, the eye-opening time was significantly prolonged, the incidence of hypertension during operation, and restlessness, hypertension, and tachycardia during recovery from anesthesia was signi