右美托咪定对腹腔镜下胆囊切除术患者血流动力学的影响

目的观察全麻诱导前给予右美托咪定对于腹腔镜下胆囊切除术（LC）患者血流动力学的影响。方法40例ASAI～II级择期行Lc的患者，完全随机分为右美托咪定组和生理盐水组，各20例。右美托咪定组于全麻诱导前静脉泵注右美托咪定1μg/kg，泵注时间为10min，生理盐水组以同样的速率静脉泵注相同容量的生理盐水，2组全麻诱导均使用咪达唑仑0．05mg／kg、丙泊酚1mg／kg、芬太尼4μg/kg、顺苯磺酸阿曲库铵0．2mg／kg，术中以七氟醚吸入维持麻醉，观察记录静脉泵注开始前（T0）、静脉泵注10min后（T1）、气管插管后即刻（T2）、手术结束时（T3）、气管拔管即刻（T4）、气管拔管后5min（T5）气管拔管后10min（T6）7个时间点的脑电双频指数（BIS）、MAP、HR，并记录苏醒时间、拔管时间，拔管后进行Ramsay镇静评分，观察有无呛咳、恶心、呕吐等不良反应。结果右美托咪定组患者行气管插管、气管拔管时血流动力学更平稳（P〈0．05）。有美托咪定组苏醒时间（19±5）min，拔管时间（22±4）min，生理盐水组分别为（18±4）min、（22±4）min，2组比较差异均无统计学意义（均P〉0．05）。术后右美托咪定组无躁动、寒战、恶心、呕吐发生，生理盐水组有1例躁动，2例寒战。结论术前预给右美托咪定可以使腹腔镜下胆囊切除术患者气管插管和拔管期间血流动力学更平稳，不影响麻醉苏醒和拔管时间，术后躁动、寒战、恶心、呕吐发生率更低。

Effect of dexmedetomidine on hemodynamics in old patients undergoing laparoscopic cholecystectomy

Objective To study the effect of dexmedetomidine before general anesthesia on hemodynamics in old patients undergoing laparoscopic cholecystectomy. Methods Forty American society of anesthesiologists （ASA） Ⅰ- Ⅱ patients undergoing laparoscopie eholecystectomy were randomly divided into dexmedetomidine group （ n = 20） and physiological saline group （ n = 20） ： dexmedetomidine group had dexmedetomidine and physiological saline group had saline; two groups used same drugs for induction of general anesthesia. Observation timepoints included： before pump injection （T0 ）, after pump 10 min （T1）, after tracheal intubation （T2 ）, after the end of the surgery （ T3 ）, tracheal drawing tube immediate （ T4 ）, 5 rain after tracheal drawing tube （ T5 ）, after tracheal drawing tube 10 min （T6 ）; bispectral Index （BIS）, MAP, HR, waking time （T1 ）, tracheal drawing tube time （ T2 ） , and adverse reactions such as choke cough, nausea and vomiting were all observed. Results Hemodynamic of tracheal intubation and tracheal extubation in dexmedetomidine group was stable （ P 〈 0. 05 ）. The recovery time and extubation time in dexmedetomidine group and saline group were （ 19 ± 5 ） min, （ 22 ±4 ） rain and （ 18 ± 4 ） min, （ 22± 4） min, respectively ; the difference were not statistically significant （ P 〉 0. 05 ）. No postoperative agitation, chills, nausea and vomiting occurred in dexmedetomidine group. Saline group had 1 case of restlessness and 2 cases of shivering. Conclusion Preoperative dexmedetomidine may make hemodynamics more smoothly in patients with laparoscopic choleeystectomy during tracheal intubation and extubation without affecting the anesthesia recovery and extubation time, showing a low rate of postoperative agitation, chills, nausea and vomiting.