术中单次输注右美托咪定对甲状腺切除手术血流动力学的影响

The effect of intraoperative single-dose infusion dexmedetomidine on hemodynamic in patients undergoing thyroidectomy

目的研究术中单次应用右美托咪定对甲状腺切除手术血流动力学的影响及安全性。方法选取择期上午8:00～9:00接受甲状腺手术病人67例,随机分为右美托咪定组(Ⅰ组,34例)和生理盐水组(Ⅱ组,33例)。Ⅰ组麻醉诱导后立即给予右美托咪定1μg/kg微泵持续输注10min。Ⅱ组按相同方法给予等容量生理盐水。记录给药前(T0)、给药5min后(T1)、切皮时(T2)、切除甲状腺时(T3)、拔管时(T4)、出手术室(T5)HR、SBP和DBP;记录手术中丙泊酚用量,苏醒期患者呼吸恢复睁眼时间和拔管时间,术后Ramesay镇静评分。结果 T1～T5时Ⅰ组HR明显慢于、SBP、DBP明显低于Ⅱ组(P<0.01或P<0.05);T1～T4时Ⅱ组SBP、DBP明显高于T0时(P<0.05或P<0.01)。术中Ⅰ组丙泊酚用量明显低于Ⅱ组(P<0.05),术后Ramesay镇静评分Ⅰ组明显高于Ⅱ组(P<0.01)。结论单次注射右美托咪定有利于甲状腺手术中的血流动力学的稳定,减少麻醉药用量,而不影响拔管时间。

Objective To observe the effect and safety of introperative single-dose dexmedetomidine on hemodynamic in patients undergoing thyroidectomy. Methods sixty-seven patients undergoing thyroidectomy were randomized to two groups： dexmedtomidine group （group Ⅰ ） received a single intraoperative dose of Dex 1 μg/kg infusion（ 10 min） and control group （group Ⅱ ） received saline infusion as the same. HR, SBP, DBP were recorded at the time points of pre- operation（T0 ）, 5 min after administration （T0）, skin incision （T2）, when dissecting thyroid （T3）, intubation（T4 ）, when going out of operating room（T5 ）. Each patient of spontaneous breath recovery and intubation time were also recorded. The total dosage of protocol and Ramsey scale were observed. Results HR was significantly slowed, SBP, DBP were obviously decreased at T1-T5 in group Ⅰ compared with group Ⅱ （P〈0. 01 or P〈0.05）. In group Ⅱ at T1 -T4 was increased compared with To （P〈0. 05）. The total dosage of protocol decreased by 18. 4% in group I than group Ⅱ. There was significant difference in sedation scores in two groups（P〈0. 05）. But the spontaneous breath recovery and intubation time were similar between two groups. Conclusion A single intraoperative dose of Dex is better in stabilizing hemodynamic, reducing protocol requirements, without increasing intubation time.