| Objective: To compare the anesthesia effects of dexmedetomidine with different doses compound remifentanyl and propofol on the burned patients during the short general operation.Methods: sixty patients was selected with 3% area of the burned skin graft or 10% ~ 50% area burn dressing, ages 18 to 55 years old, ASA Ⅰor Ⅱlevel, without hypertension, sinus bradycardia, atrioventricular block, severe respiratory system disease, randomly divided into 3 groups(n = 20),According the dexmedetomidine totally maintenance dose were 0.6 μg /kg/ h(group A), 0.8μg /kg/ h(group B) and 1 μg /kg/ h(group C) infusion. dexmedetomidine was loaded(1 μg /kg) at the begin of anesthesia induction and was infused with different doses(0.6,0.8,1.0μg /kg /h) during surgery. While anesthesia induction was induced with a target-controlled infusion(TCI) of propofol and remifentanil. The TCI-propofol and TCI-remifentanil(remifentanyl target plasma concentration of 3.0 to 5.0 ng/ml; propofol target plasma concentration of 1 u g/ml) were adjusted to a depth of anesthesia(IOC) index of 40-60. If the Sp O2 fell below 90%, to insert a laryngeal mask to help breathe. Mean arterial blood pressure(MAP), heart rate(HR),pulse oxygen saturation(Sp O2) and depth of anesthesia(IOC) were recorded at baseline(T0), after anesthesia induction(T1), skin or hydrogen peroxide rinse(T2) and the end of surgery(T3), at the same time collecting venous blood 3 ml at T1, T2, T3 time, using ELISA method to detect cortisol concentration. record the operation time, patients wake up time(stopped taking the drug to open eye) and in the incidence of laryngeal mask. Ramsay score was evaluated after operation; Vas score was recorded at postoperative 6 hours and postoperative 24 hours and intraoperative know during the operation.Results:1 The comparation between group with three groups’ s age、body mass index、operation time and wake up time had no statistical difference(P > 0.05).2 The comparation between group with MAP 、HR 、SPO2 was not statistical difference(P > 0.05).The comparation in each group with MAP 、HR at T0 was significant statistical(P < 0.05), HR within three group were declining gradually,but not lowed to 50 every min.3 The Cor comparation between three groups had no statistical difference(P > 0.05); The Cor comparation In each group, T2 and T3 、T1 and T3 was compared statistically significant(P < 0.05),the comparation on T1 and T2 was statistically significant in group A(P<0.05),was not statistically significant In groups B and C(P > 0.05).4 Postoperative Ramsay score of group B、C was lower than group A, it was statistically significant(P < 0.05). Comparation between groups B and C was no statistical difference( P > 0.05).5 The Vas score of 6 hours after operation in group B、C was lower than that in group A,It was significant statistical(P < 0.05). Comparation between groups with Vas score of 24 hours after operation was not statistical difference(P > 0.05).6 The application of laryngeal mask in group A was significantly higher than group B、C, It was significant statistical(P<0.05);comparation between groups B and C was no statistical difference(P > 0.05).7 The comparation of intraoperative target controlled infusion, the remifentanyl was not statistical difference between three groups(P > 0.05); The comparation of propofol concentration on group A was obviously higher than group B、C, It was significant statistical(P<0.05); The comparation in B, C groups was not statistical difference(P > 0.05).Conclusion: Dexmedetomidine with 0.8ug/kg/h maintaince compound remifentanyl and propofol to anesthesia can safly and calmly during the operation in Short surgery of burn patients, and make patients comfortable through operation. |
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