右美托咪啶在活体肾移植供者全麻拔管期的应用

Application of Dexmedetomidine During Extubation Period in Donors of Living-related Renal Transplants

目的观察右美托咪啶对活体肾移植供者全麻拔管期的影响。方法将全麻下行腹腔镜供肾切除术的40例患者随机分为右美托咪啶组（D组,n=20）和对照组（N组,n=20）。两组患者全麻诱导和维持相同,术毕前10 min停用麻醉维持药物,同时D组缓慢静脉注射右美托咪啶（0.5μg/kg）,N组以相同速率给予相同容量的生理盐水。观察并记录麻醉前（T0）、拔管时（T1）、拔管后2 min（T2）、5 min（T3）、10 min（T4）时的平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）,术后1、6、12 h的视觉模拟评分（VAS）及拔管时患者是否出现躁动等不良反应。结果与T0时比较,对照组患者MAP和HR于T1~3时升高（P〈0.05或P〈0.01）,于T4时,逐渐恢复至麻醉前水平（P〉0.05）;右美托咪啶组MAP、HR及两组患者的SpO2于各时点无显著变化（P〉0.05）。观察组T1~3时的MAP、HR及术后1 h的VAS评分和躁动发生率均低于对照组（P〈0.05或P〈0.01）。结论活体肾移植供者全麻拔管期应用右美托咪啶可明显降低心血管反应及躁动发生率,同时有早期术后镇痛作用。

Objective To observe the effect of dexmedetomidine on the donors of living-related renal transplants during extubation period of general anesthesia.Methods Forty donors of living-related renal transplants underwent nephrectomy by laparoscopes were randomly divided into 2 groups,dexmedetomidine group（group D,n=20） and control group（group N,n=20）.The methods of induction and maintenance of anesthesia of the two groups were identical,and all the anesthetics were stopped 10 minutes before the end of the surgery.In Group D,dexmedetomidine was infused continuously slowly（0.5 μg/kg）,and equal volume of normal saline was given in group N instead of dexmedetomidine.Heart rate（HR）,mean arterial blood pressure（MAP）,Sp02 of the patient at the time of baseline（T0）,extubation（T1）,2 minutes after extubation（T2）,5 minutes after extubation（T3）,10 minutes after extubation（T4） were recorded.Values of visual analogue scale（VAS） at the time of 1,6,12 hours after extubation and incidence of agitation during extubating were observed.Results MAP and HR of group N were higher at T1,T2 and T3 than at T0（P0.05 or P0.01）,and come down to the level of T0 at T4（P0.05）.MAP and HR of group D and SpO2 of the two groups did not change significantly（P0.05）.Compared with group N,MAP and HR at T1 to T3,VAS at 1 hour after surgery and the incidence of agitation during extubation of group D were lower（P0.05 or P0.01）.Conclusion Application of dexmedetomidine during extubation period of general anesthesia in donors of living-related renal transplants could decrease the stress response and the incidence of agitation significantly,and was profited to the inchoate postoperative analgesia.