| Objective:The right of dexmedetomidine hydrochloride in the role of anesthesia extubation on laparoscopic operation, and to explore the reasonable dose of its clinical application。Methods:Select intravenous and inhalation anesthesia in patients undergoing elective on laparoscopic surgery under the120cases, aged22to65years of age;53males,67females; weight (kg) in the standard body weight±20%; all cases there was no severe preoperative hypertension; Liver and kidney dysfunction, endocrine and nervous system disorders。Anesthesia was induced with midazolam0.05mg/kg, fentanyl2～4μg/kg, propofol1.5～2mg/kg and vecuronium0.1mg/kg。 Intraoperative infusion of propofol4～10mg/kg/h and remifentanyl0.2～0.4μg/kg/min, intermittent intravenous vecuronium0.04mg/kg, inhalation of1to0.2%Isoflurane until skin closure, patients no use of antiemetic drugs, surgery before the end of20min no use of muscle relaxants and analgesics, surgery before the end of lmin stop intraoperative infusion of propofol and remifentanyl, the end of surgery were transferred to PACU。Into the PACU patients were randomly divided into4groups:control group, propofol (P group) and test group (D group), experimental group was divided into D1, D2, D3three subgroups,30cases in each group。P group of target-controlled infusion of propofol, plasma concentration is set to1μg/ml; D1group, D2group, D3DEX group were given a loading dose0.3μg/kg,0.5μg/kg,0.7μg/kg,10min by slow intravenous injection pump, the maintenance dose were0.3μg/kg/h,0.5μg/kg/h,0.7μg/kg/h; patients resumed spontaneous breathing was discontinued。Each blood pressure (BP), heart rate (HR), pulse oxygen saturation (SpO2), bispectral index (BIS), cardiac (ECG), end-tidal carbon dioxide partial pressure (PETCO2), end-expiratory anesthetic concentration, urine volume, body temperature, blood gas analysis is routine monitoring。Patients transferred to PACU with ventilator control ventilation, inspired oxygen concentration60%, tidal volume8～10ml/kg, respiratory rate10to12times/min, maintained PETCO2at35～45mmHg, end-tidal anesthetic concentration was reduced to0.2%Time to stop mechanical ventilation, use of manual respiration until the patient resumed spontaneous breathing。Extubation in patients with indications for extubation to meet standards from the room to switch out the PACU。 SBP, DBP, HR and BIS of patients were drawn following7time points: preoperatively (To), immediately transferred to PACU (before administration, T1), after administration10min(T2), spontaneous breathing (T3), Suction extubation (T4), after extubation10min (T5), turn out the PACU immediately (T6)。Extubation in patients with cough response was observed。Spontaneous breathing recovery time, call time to eye opening, extubation time, visual analog score (visual analogue scale, VAS), and PACU stay were recorded。Respiratory depression, hypertension, hypotension, tachycardia, bradycardia, nausea, vomiting, chills, and restlessness were observed。Spss13.0software was used for statistical analyses。Measurement data is expressed by mean(x)±standard deviation(s), Group at each time point were analyzed by ANOVA, Repeated measures AN OVA was used to compare between groups, count data were analyzed by χ2test,P<0.05considered statistically significant difference。Results:Four groups of patients in gender, age, height, weight, type of surgery, operative time, end-tidal anesthetic concentration decreased to0.2%of the time so there was no significant difference (P>0.05)。Compared with To; P group of SBP, DBP in the T5, HR was significantly higher in T4and T5(P<0.05); D1group of SBP, DBP in the T4, HR at T4and T5weresignificantly increased (P<0.05); D2group at each time point compared with To was no significant difference (P>0.05); D3group of SBP in the T2, DBP increases in T2-4, HR slowed down in the T2,3(P<0.05)。And the P group, D1group at each time point SBP, DBP and HR with no significant difference between P group (P>0.05), BIS T2,3was higher than in P group, spontaneous breathing, call eyes, extubation and PACU stay wassignificantly shorter (P<0.05), extubation quality with no statistically significant difference (P>0.05); D2group of SBP, DBP, HR at T4,5were significantly decreased, BIS in T3higher than the P group, spontaneous breathing recovery time, calls for open eyes and PACU stay was significantly shorter, VAS decreased extubation quality is better than P group, extubation rate of hypertension (P<0.05); D3group The SBP, DBP transient increase in T2-4lower, HR slowed down in the T2-5, BIS in T2,3, T5significantly lower than the P group was significantly shorter recovery time of spontaneous breathing, extubation time extension, VAS decreased extubation quality is better than P group (P<0.05)。Compared with the D1, D2group of SBP, DBP in the T4、T5were significantly decreased, HR decreased in the T3-5, BIS in group T2,3less than Dl, Dl extubation quality is better than group, extubation rate of hypertension (P<0.05); D3group SBP increased in the T2, T4lower, DBP decreased in the T4, HR decreased in T2-5, BIS in T2.3、T5lower, calls for open eyes,extubation, and PACU stay were prolonged, the quality is better than Dl extubation group (P<0.05)。 Compared with the D2, D3group of SBP, DBP increases in T2, HR decreased at T2, BIS in T2,3、T5reduced call time to eye opening, extubation, and PACU stay for a longer (P<0.05), extubation quality showed no significant difference (P>0.05). Conclusion:1.DEX possess a dose-dependent sedation, analgesia, anesthesia extubation patients can process more stable hemodynamics, and reduce the cough response, reduce postoperative pain and improve the quality of extubation。2.0.5μg/kg of DEX sedation moderate, stable hemodynamics, mild cough, pain is better, fewer complications, does not affect the analepsia time,more suitable for extubation anesthesia application。... |
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