右旋美托嘧啶在妇科开腹手术异氟醚麻醉苏醒期的应用

The application of dexmedetomidine in isoflurane anesthesia recovery period with gynecological laparotomy

目的:探讨妇科开腹手术患者在异氟醚吸入麻醉苏醒期应用右旋美托嘧啶对麻醉苏醒恢复的影响。方法:50例择期行妇科开腹手术的患者,随机分为右旋美托嘧啶组(Dex组)和对照组(Control组):Dex组,手术结束前10 min静脉注射1μg·kg-1的右旋美托嘧啶;Control组,手术结束前10 min给与1μg·kg-1的右旋美托嘧啶剂量的等体积生理盐水。并监测测患者诱导前基础值(T1),用药前(T2),用药后(T3),拔管即刻(T4)、拔管后1 min(T5)、3 min(T6)、5 min(T7)、15 min(T8)患者的平均动脉压MAP、心率HR、脉搏血氧饱和度SpO2值,记录患者的自主呼吸恢复时间、拔管时间、躁动评分、呛咳评分以及发生的不良反应。结果:Control组在拔管即刻(T4)、拔管后1 min(T5)、3 min(T6)、5 min(T7)的MAP及HR明显高于Dex组(P<0.05);与诱导前(T1)相比,Control组在T4～T7时间点MAP和HR明显增高(P<0.05)。与Control组相比,Dex组的躁动评分及呛咳评分也显著降低(P<0.05),高血压、心动过速及寒颤等不良反应也明显减少(P<0.05),但是其心动过缓的发生率去高于Control组(P<0.05)。结论:在异氟醚吸入麻醉苏醒期给与右旋美托嘧啶,可以维持患者麻醉苏醒过程中血流动力学的稳定,减少苏醒过程中的躁动、寒颤及恶心呕吐等不良反应的发生,同时没有明显的呼吸抑制及苏醒延迟。

OBJECTIVE To study the application of dexmedetomidine in isoflurane anesthesia recovery period with gyneco- logical laparotomy. METHODS Fifty patients with elective gynecological laparotomy surgery were randomly divided into two groups. Dexmedetomideine group （Dex Group） ：Intravenous injection dexmedetomidine of 1 μg·kg^-1 at 10 minutes before the end of surgery; Control group： received the same amount of saline instead of dexmedetomideine. Mean arterial pressure（MAP）, heart rate （HR）and pulse oximetry （SPO2） were recorded at the time of baseline（T1）, before injection dexmedetomidine or sa- line（T2）, completion of dexmedetomidine or saline infusion （T3）, during extuhation （T4）, 1,3,5,15 minute after extubation （T5, T6, T7, T8）. The durations from discontinuation of isoflurane administration to spontaneous breath, extubation and orien- tation and the incidence of adverse effects were observed. RESULTS MAP and HR of control group increased at T4 - T7 com- pared with T1 （P〈0. 05）. Compared with Dex group,MAP and HR in Control group were significantly higher at T4- T7 （P〈0.05）. The agitation scores, cough scores of group Dex were lower than the control group （P〈0. 05）. Hypertension, tachycar dia,and chills,and other adverse reactions were significantly reduced in the Dex group, but the incidence of bradycardia was higher than the control group （P〈0. 05）. CONCLUSION In the recovery period of isoflurane anesthesia, the infusing of dexmedetomidine before extubation can keep the patients in a stable hemodynamic state and with less agitation, chills, nausea and vomiting and other adverse reactions,while no significant of respiratory depression and delayed recovery.