右美托咪定用于困难气道患者苏醒期拔管时的镇静效果

Study of dexmedetomidine sedation during extubation in patients with difficult airway

目的:观察右美托咪定用于困难气道患者苏醒期拔管时的镇静效果及其对血流动力学的影响。方法:选择ASAⅠ～Ⅱ级、择期全麻下行口腔颌面部肿瘤切除术的困难气道患者(Mallampati分级≥Ⅲ级)30例,随机分为2组(每组15例)。所有患者在手术结束前10min分别静脉推注生理盐水(NS组)或右美托咪定0.5μg/kg(DEX组),推注时间为10min。比较2组的拔管时间、苏醒拔管期间患者呛咳和躁动的情况以及患者对拔管事件的回忆情况;观察HR、SBP、DBP、RR的变化和不良事件发生率。采用SAS 9.13软件包对数据进行统计学处理。结果:2组拔管时间无显著差异(P>0.05)。拔管期间DEX组呛咳评分和躁动评分显著低于NS组(P<0.01);Ramsay评分和回忆度评分显著高于NS组(P<0.01)。与诱导前相比,用药后DEX组HR、SBP、DBP均显著降低(P<0.01),拔管时HR、SBP略上升,拔管后1、5、10min时HR、SBP、DBP、RR与诱导前无明显差异(P>0.05);NS组HR、SBP、DBP在苏醒拔管期间均显著高于诱导前,且高于DEX组(P<0.01)。NS组寒颤发生率高于DEX组(P<0.05)。结论:右美托咪定用于困难气道患者苏醒期拔管,能明显减少患者呛咳和躁动,产生良好的遗忘作用,且不延长拔管时间。

PURPOSE：To observe the sedative effect of dexmedetomidine during extubation in patients with difficult airway.METHODS：Thirty patients,Mallampati score≥Ⅲ,receiving an elective maxillofacial tumor resection,were randomly divided into two groups.10 min before the end of the surgery,dexmedetomidine at a dose of 0.5μg/kg in Group DEX（n=15） and saline in Group NS（n=15） were administrated intravenously over 10 min.Coughing,dysphoria,duration of extubation,and recall of extubation were noted.HR,SBP,DBP,RR and incidence of adverse events were recorded as well.SAS 9.13 software package was used for data processing.RESULTS：There was no significant difference in the duration of extubation between the two groups.Group DEX had significant lower coughing score and dysphoria score than Group NS during extubation（P0.01）,and also had higher Ramsay score and recall score.In Group DEX,HR,SBP and DBP decreased obviously after administration（P0.01）,slightly increased during extubation and no obvious changes at 1,5,10 min after extubation（P0.05）.While in Group NS,HR,SBP,DBP were all significantly higher than before induction or those in DEX group during extubation（P0.01）.Higher incidence of chills was observed in Group NS（P0.05）.CONCLUSIONS：Dexmedetomidine is effective in attenuating coughing,dysphoria and hemodynamic changes during extubation for patients with difficult airway.It can provide better amnestic level and do not extend the duration of extubation.