苏醒期静脉注射右美托咪啶对全身麻醉拔管的影响

Effect of Intravenous Injection of Dexmedetomidine during Recovery from General Anesthesia on Tracheal Extubation

目的观察右美托咪啶(Dexmedetomidine,DXM)用于全身麻醉(全麻)苏醒期拔管时的镇静效果及其对血流动力学的影响。方法选取全麻腹部手术患者50例,手术结束后转入苏醒室。按照随机数字表法将其分为2组:右美托咪啶组(Dex组,n=25)静脉输注右美托咪啶0.4μg.kg-1(将右美托咪啶稀释成4μg.mL-1,输注时间为10min),生理盐水对照组(NS组,n=25)给予同等容量生理盐水,给药方法和时间同Dex组。记录给药前(T1,基础值)及给药后10min(T2)、拔管即刻(T3),拔管后5min(T4)、10min(T5)、20min(T6)患者的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)、镇静评分(RSS)。记录患者呼吸恢复时间、拔管时间、出室时间,以及患者躁动、寒战等并发症发生情况。结果 2组患者在年龄、体质量、麻醉时间、手术时间、拔管时间、出室时间差异无统计学意义(P>0.05)。Dex组患者苏醒期各时间点MAP差异无统计学意义;Dex组患者拔管时HR无显著升高,拔管后HR(T4,T5)比基础HR慢(P<0.05),而NS组患者T3和T4的MAP、HR显著高于Dex组及基础值(P<0.05)。在T3-T6时间点Dex组RSS评分显著高于NS组(P<0.05),Dex组躁动发生率显著低于NS组(P<0.05)。结论全麻苏醒期静注0.4μg.kg-1右美托咪啶,能维持拔管期间患者血压和HR稳定,降低躁动发生率。

ABSTRACT： Objective To observe the sedative efficacy of dexmedetomidine during extubation in patients with recovery from general anesthesia and its effect on hemodynamics. Methods Fifty patients were allowed to recover from anesthesia and transferred to recovery room after abdominal surgery. These patients were randomly divided into two groups,with 25 patients in each group. Patients in Dex group were given intravenous infusion of 0.4μg.kg-1 dexmedetomidine （dexme- detomidine was diluted to a final concentration of 4μg.kg-1 ,infusion time was 10 minutes）. Pa- tients in NS group were injected with the same volume of saline. The mean arterial pressure （MAP） ,heart rate （HR）,oxygen saturation （SpOx） and Ramsay sedation score （RSS） were re- corded before infusion （T1）,10 minutes after infusion （T2）,at extubation （T3）,and 5,10 and 20 minutes after extuhation （T4,T5 and T6）. Recovery time of breathing,time to extubation, time of leaving the room, and incidence of agitation, chills and other complications were observed in both groups. Results There were no significant differences in age, weight, anesthesia time, opera-tive time,time to extubation and time of leaving the room between the two groups. In Dex group, no obvious differences in MAP were found among different time points and no increase in HR was observed at T3,but HR at T4 or T5 was lower than basic HR（P〈0.05）. In NS group,MAP and HR at T3 or T4 were higher than basic HR（P〈（0.05）. Compared with Dex group,MAP and HR at T3 and T4 and RSS at T3-T6 significantly increased but incidence of agitation obviously de- creased in NS group （P〈0.05）. Conclusion Intravenous infusion of 0.4μg.kg-1 dexmedetomi- dine during recovery from general anesthesia can maintain stable blood pressure and HR and re- duce the incidence of agitation during extubation.