盐酸多沙普仑对右旋美托咪定全麻恢复期催醒效果临床观察

Clinical Observation of Wakening Effect of Doxapram in Recovery Stage under General Anesthesia with Dexmedetomidine

[目的]观察盐酸多沙普仑用于右旋美托咪定全麻患者围麻醉期的催醒效果及不良反应.[方法]择期成人骨科全麻手术40例,随机分为两组,每组20例.A组：右旋美托咪定（DEX）＋盐酸多沙普仑（DOX） B组：DEX＋生理盐水.麻醉诱导插管后5 min开始,两组均给予DEX负荷量1 μg/kg,既以 0.6～0.8 μg/（kg·min）泵注维持,术毕前10 min停药.A组术毕拔管后即刻给予DOX 1 mg/kg,B组给予等体积生理盐水.观察两组患者诱导前5 min（T0）、插管后 5 min（T1）、停止所有麻醉药时（T2）、拔管时（T3）、拔管后5 min（T4）时的收缩压（SBP）、舒张压（DBP）、心率（HR） 患者术前（T＇0）、拔管时（T＇1）及拔管后 10 min（T＇2）Riker镇静、躁动评分（SAS） 及术后不良反应情况.[结果]两组患者一般资料具有可比性（P〉0.05） 各时点SBP、DBP、HR组间比较无差异（P〉0.05） SAS评分在T＇2时A组高于B组,差异有显著性（P〈0.05）, 两组患者拔管反应评分及恶心呕吐、寒颤、术中知晓等发生率比较无差异（P〉0.05）.[结论]右旋美托咪定用于麻醉维持可提供良好的血流动力学稳定性和镇静作用,全麻恢复期更平稳 多沙普仑对右旋美托咪定麻醉术后的催醒效果确切,血流动力学波动幅度小,不良反应发生率低.

[Objective]To observe the wakening effect and adverse reaction of doxapram（DOX） in patients at peri anesthetic stage under general anesthesia with dexmedetomidine（DEX）. [Methods] Forty adult patients undergoing bone surgery under general anesthesia were randomly divided into two groups with 20 cases in each. Group A was given DEX and DOX. Group B was given DEX and normal saline. After 5min induction, both groups were given DOX 1μg,/kg with loading dose, and then were maintained by pump administration of 0.6-0.8μg/（kg o rain）, and drugs were stopped at 10 min before surgery. At the moment of extubation, group A was given DOX lmg/kg, and group B was given isovolumic normal saline. Systolic blood pressure （SBP）, diastolic blood pressure（DBP） and heart rate（HR） at 5min before induction（T0 ）, 5min after intuba tion（T1 ）, drug withdrawal（T2）, intubation（T3） and 5rain after intubation（T4） were observed in two groups. Riker sedation agitation scale（SAS） and adverse reactions during peri anesthesia before operation（T0 ）, intubation（T1） and 10min after intubation（T2 ） were also observed. [Results]The demography data in two groups had comparability（ P〉0.05）. There was no significance in SBP, DBP and HR at every point between two groups（ P〉0.05）. The SAS score at T2 in group A was higher than that in group B, and there was signifi cant difference between two groups（ P〈0.05）. There was no significant difference in the incidence of extubation reaction score, nausea and vomiting, shivering and intraoperative awareness between two groups（ P〉0. 05）. [Conclusion] DEX used in the maintenance of anesthesia can provide stable hemodynamics, good sedation and more stable during recovering period of general anesthesia. DOX for the consciousness recovery after anesthesia with DEX is effective, and has little changes of hemodynamics and low incidence of adverse reactions.