右美托嘧啶在甲状腺手术全麻拔管期间的应用

The Application of Dexmedetomidine in Extubation of General Anesthesia in Thyroid Surgery

目的:探讨甲状腺手术患者在全麻拔管期间应用右美托嘧啶(dexmedetomidine,DEX)对血流动力学、呼吸和疼痛的影响。方法:60例患者行甲状腺手术,随机分为右美托嘧啶组(A组):术毕前10min按0.5μg/kg计算浓度为2μg/mL右美托嘧啶溶液量,用微泵10min静脉注射完毕;对照组(C组):术毕前10min抽取与按0.5μg/kg计算2μg/mL右美托嘧啶溶液所需量等量的0.9%氯化钠液在10min内微泵静脉注射完毕。观察并记录:基础值(T1)、右美托嘧啶或0.9%氯化钠液输注前(T2)、输注后(T3)、拔管过程中(T4)、拔管后1min(T5)、拔管后15min(T6)患者心率、血压、脉氧饱和度;记录苏醒时间和拔管时间、拔管时躁动评分、呛咳评分、拔管后患者Ramsay镇静评分和疼痛视觉模拟评分(VAS);记录药物输注后至患者离开麻醉恢复室之间所发生的不良反应。结果:右美托嘧啶组在药物输注完毕、拔管过程中及拔管后1min后血压和心率与对照组相比降低(P<0.05),拔管时躁动评分、呛咳评分及疼痛模拟评分均低于对照组(P<0.05)。右美托嘧啶组心动过缓和低血压发生率高于对照组(P<0.05)。结论:甲状腺手术患者在全麻苏醒拔管之前应用右美托嘧啶微泵注射,能使患者处于舒适的镇静状态,保持循环稳定及充分镇痛,同时不明显延长术后苏醒时间和拔管时间。

Objective：To dissuss the efficiency of application of dexmedetomidine in extubation of general anesthesia in thyroid surgery.Methods：A total of 60 patients with the American Society of Anesthesiology（ASA） Ⅰ-Ⅱ underwent resection of the thyroid gland or resection of thyroid carcinoma were randomly divided into 2 groups.Dexmedetomidine group（Group A）：calculated the amount of 2 μg/mL dexmedetomidine solution based on 0.5 μg/kg and infused intravenously by a electronic micro-pump before 10 mins of the end of the surgery;The control group（Group C）： infusing the same amount of saline instead of dexmedetomidine.Observing and recording HR,SP,DP,SpO2 of the patient at the time of baseline（T1）,before infusing of dexmedetomidine or saline（T2）,completion of dexmedetomidine or saline infusion（T3）,during extubation（T4）,1 minute after extubation（T5）,15 minute after extubation（T6）.Recording awaken time and extubation time,extubation agitation scores,cough scores,Ramsay sedation scores after extubation and pain of visual analogue scale（VAS）.Recording the adverse events（arrhythmia,PONV,laryngospasm.etc）occurred in patients before leaving the PACU.Results： The blood pressure and heart rate of dexmedetomidine group were lower than the control group at the time of completion of drug infusion;during extubation and 1 minute after extubation（P〈0.05）.The agitation scores,cough scores and VAS of dexmedetomidine group were also lower comparing with the control group（P〈0.05）.More transient bardycardia and hypotension occurred in dexmedetomidine group（P〈0.05）.Conclusions： In patients underwent thyroid surgery,the infusing of dexmedetomidine before extubation can make patients a comfortable sedation and stable hemodynamic state with adequate pain relief,while no significant delaying of awaken and extubation time.