右美托咪定多模式给药在胸科麻醉中的应用

Multi-mode administration of dexmedetomidine for thoracic surgery anesthesia

目的 探讨右美托咪定在胸科手术中合理有效的用药方案和安全的用药方法.方法 选择行择期开胸手术的患者80例,ASA分级Ⅰ～Ⅱ级.按随机数字表法分为四组,每组20例.四组均行肋间神经阻滞.A组：麻醉前右美托咪定＋关胸前布比卡因;B组：麻醉前右美托咪定＋关胸前右美托咪定复合布比卡因;C组：麻醉前0.9％氯化钠＋关胸前布比卡因;D组：麻醉前0.9％氯化钠＋关胸前右美托咪定复合布比卡因.分别记录右美托咪定或0.9％氯化钠输注前（T0）、右美托咪定或0.9％氯化钠输注后（T1）、气管插管即刻（TO、气管插管后3 min（T3）、气管插管后5 min（T4）的平均动脉压（MAP）、心率（HR）以及术后疼痛视觉模拟量表（VAS）评分和术后镇痛药应用的情况.结果 四组患者性别构成、年龄、体重和手术时间比较差异均无统计学意义（P＞0.05）.与本组T0时比较,A组和B组T1时MAP、HR下降,C组和D组T2时MAP、HR升高,差异有统计学意义（P＜0.05）.C组和D组T2、T3时MAP、HR高于A组和B组,差异有统计学意义（P＜0.05）.术后12h时,B组和D组的VAS评分分别为（2.47±1.43）、（2.00±1.68）分,低于A组和C组的（4.78±1.26）、（4.88±1.62）分,差异有统计学意义（P＜0.05）.术后12h镇痛药给药次数B组和D组分别为（0.6±0.4）、（0.8±0.1）次,明显少于A组和C组的（1.3±0.5）、（1.5±0.4）次,差异均有统计学意义（P＜0.05）.结论 麻醉诱导前应用右美托咪定,能够安全有效地抑制双腔气管导管的插管反应,保持围手术期血流动力学的稳定;右美托咪定复合布比卡因应用于肋间神经阻滞能够提高术后镇痛效果,并延长术后镇痛的有效时间.

Objective To investigate the reasonable and effective administration ofdexmedetomidine for thoracic surgery anesthesia.Methods Eighty ASA Ⅰ-Ⅱ patients,aged 18-60 years old scheduled for elective thoracotomy were randomly assigned to 4 groups（each 20 patients）.Group A：dexmedetomidine before anesthesia induction ＋ bupivacaine before closed thorax cavity.Group B：dexmedetomidine before anesthesia induction ＋ dexmedetomidine and bupivacaine before closed thorax cavity.Group C：0.9％ sodium chloride before anesthesia induction ＋ bupivacaine before closed thorax cavity.Group D：0.9％ sodium chloride before anesthesia induction ＋ dexmedetomidine and bupivacaine before closed thorax cavity.Mean arterial pressure （MAP） and heart rate （HR） were measured before infusing dexmedetomidine or 0.9％ sodium chloride （T0）,after infusing dexmedetomidine or 0.9％ sodium chloride （T1）,instant time after intubation （T2） and 3 min after intubation （T3）,5 min after intubation （T4）.The scores of visual analogue scale（VAS） and the consumption of analgesics were compared.Results There was no significant difference including gender,age,weight and operation time among four groups （P ＞ 0.05）.Compared with T0,MAP and HR were significantly decreased at T1 in group A and group B （P ＜ 0.05）,and were significantly increased at T2 in group C and group D （P＜ 0.05）.Respectively compared with group A and group B,MAP and HR were significantly increased at T2,T3 in group C and group D （P ＜ 0.05）.The scores of VAS in group B [（2.47 ± 1.43） scores] and group D [（2.00 ± 1.68） scores] were lower than those in group A [（4.78 ± 1.26） scores] and group C [（4.88 ± 1.62） scores] after operation 12 h.The times of using postoperative analgesics in group B [（0.6 ± 0.4） times] and group D [（0.8 ± 0.1） times] were significantly less than those in group A [（1.3 ± 0.5） times]and group C [（1.5 ± 0.4） times] （P ＜ 0.05）.Conclusions Intravenous dexmedetomidine before anesthesia induction can control the effect of double-lumen endobronchial tube responses and make hemodynamics stable.Intercostal nerve block with 0.5 μ g/kg bupivacaine and 0.375％ dexmedetomidine can enhance the analgesia effect and prolong the analgesia time.