预注右美托咪定的镇静效应及其对全麻患者气管插管反应的影响

The influence of pre-injection with dexmedetomidine on sedation and tracheal intubation responses ingeneral anesthesia

目的观察预注右美托咪定对镇静及气管插管反应的影响。方法择期全凭静脉麻醉下行甲状腺次全切除术患者42例,ASAⅠ或Ⅱ级,年龄18～60岁,体重指数18～30kg/m^2,随机均分为两组:右美托咪定组(D组)和对照组(C组)。D组患者于麻醉诱导前15min静脉泵注右美托咪定0.6μg/kg(10min内泵注完毕),C组患者以同样方式泵注等量生理盐水;观察5min后开始麻醉诱导,两组患者麻醉诱导方法相同,当BIS≤45时行气管插管。记录给药前(T_0)、给药完毕即刻(T_1)、给药后5min(T_2)、插管前即刻(T_3)、插管成功后即刻(T_4)、插管成功后1min(T_5)、3min(T_6)、5min(T_7)患者的MAP、HR、SpO_2、BIS、Ramsay镇静评分;记录患者意识消失时间和BIS降至45的时间;观察并记录麻醉诱导期间的不良反应。结果与C组比较,D组患者意识消失时间和BIS降至45的时间缩短(P<0.05);与T_0时比较,T_1～T_7时D组患者MAP、BIS均降低,HR减慢,Ramsay镇静评分升高(P<0.05);T_3～T_7时C组MAP、BIS均降低,Ramsay镇静评分升高;T_3、T_6和T_7时C组HR减慢(P<0.05);与T_3时比较,T_6时D组MAP降低,T_4、T_5时C组MAP均升高,HR增快(P<0.05)。结论右美托咪定0.6μg/kg预注可产生明显的镇静作用,缩短麻醉诱导时间,有效抑制气管插管所引起的心血管反应。

Objective To observe the influence of pre-injection of dexmedetomidine on sedation and tracheal intubation responses in patients with general anesthesia. Methods Forty-two ASA Ⅰ or Ⅲ patients, aged 18-60yr, with body mass index of 18-30 kg/m2, scheduled for elective subtotal thyroidectomy under total intravenous anesthesia were randomly divided into two groups： dexmedetomidine group （group D） and comrol group （group （2）. Dexmedetomidine 0. 6μg/kg was infused intravenously 15 min prior to anesthesia induction in group D（with in 10 min）, while equal volume of normal saline was infused in group C. All the patients received the same anesthesia induction protocol. Tracheal intubation was performed when the BIS value≤45. MAP, HR, SpO2, BIS and Ramsay scores were monitored and recorded at the time points of pre-administration （To）, administration completed immediately （T1）, 5 minutes after administration （T2）, immediately pre-intubation （Ta）, immediately after successful intubation （T4）, 1 rain （T5）, 3 min （T6） and 5 min after intubation （T7）. The time when the patients losing consciousness and BIS value dropping to 45 was also recorded. Results Compared with group C, the time when the patients loskn4g consciousness and BIS value dropping to 45 was shorter in group D （P〈0. 05）. Compared with To, values of MAP, HR and BIS were significantly decreased, while Ramsay scores were significantly increased at T1-T7 in group D （P〈 0.05）. Compared with To, values of MAP and BIS were significantly decreased, while Ramsay scores were significantly increased at T3-T7 in group C （P〈0. 05） ; HR was significantly decreased at T3 ,T6 and T7 in goup C （P〈0. 05）. Compared with T3, MAP was significantly decreased at T6 in group D, Values of MAP, MR were significantly increased at T4 and T5 in group C （P%0. 05）. Conclusion Dexmedetomidine 0. 6 pg/kg prior to induction can present obvious sedation, significantly shorten the time of induction, suppress cardiovascular responses during tracheal intubation in total intravenous general anesthesia.