右美托咪定在神经外科气管切开术中的应用

Application of dexmedetomidine in tracheotomy for neurosurgical patients

目的观察盐酸右美托咪定在神经外科气管切开术中的临床应用效果。方法 60例神经外科需行气管切开术的患者,随机分为右美托咪定组(D组)和对照组(C组),D组术前先静脉泵注右美托咪定0.5μg/kg,后以0.5μg/(kg·h)速率泵注至术毕。C组输注相同容量的生理盐水。两组均在局麻下完成气管切开手术。记录两组患者麻醉前(T0),注射局麻药(T1),气管操作(T2)及术毕(T3)SBP、DBP、HR、RR和SpO2。记录两组需乌拉地尔的病例数和术中挣扎躁动患者的病例数。结果与T0时点比较,C组T1,T2时点HR、SBP、DBP、RR均明显升高(P<0.01)。D组SBP、DBP在T1,T2低于T0,HR,RR在T1时点低于T0但T2时点高于T0(均P<0.01);在T1,T2,T3各个时点,D组HR、SBP、DBP、RR均低于C组(P<0.01)。D组患者术中使用乌拉地尔和挣扎躁动的发生频率均低于C组(P<0.01)。结论右美托咪定可以减轻神经外科患者气管切开术中应激反应,减少血流动力学波动和躁动,对呼吸无抑制,值得临床推广。

Objective To investigate the clinical application of dexmedetomidine hydrochloride in tracheotomy for neurosurgical patients.Methods Sixty neurosurgical patients underwent tracheotomy surgery were randomly divided into dexmedetomidine group （group D） and control group （group C）.Dexmedetomidine 0.5 μtg/kg was infused slowly in 10 min in patients of group D by intravenous pump before operation,then at 0.5 μg/（kg.h） continuously until the end of the operation.The same volume of saline was infused continuously until the end of the operation in group C.Both two groups of tracheotomy surgery were completed under local anesthesia.The patients＇ systolic blood pressure（SBP）,diastolic blood pressure （DBP）,heart rate （HR）,saturation of pulse oxygen （SpO2） and respiratory rate （RR） were recorded in two groups at the following time points：before anesthesia （T0）,local anesthetic injection （T1）,trachea stimulation （T2）,end of the operation （T3）.The cases of urapidil injected,agitation and dysphoria were recorded.Results HR,SBP,DBP,RR at T1,T2 were significantly higher than T0 in group C （all with P ＜ 0.01）.In group D,SBP,DBP at T1,T2 were lower than T0,HR,RR at T1 were lower than T0 but higher at T2 than T0（all the P ＜ 0.01）.HR,SBP,DBP,RR in group D were significantly lower than those in group C at T1,T2,T3 （All the P ＜ 0.01）.Compared with those in group C,the incidence of urapidil injection,agitation and dysphoria in group D were significantlylower （all the P ＜ 0.01）.SpO2 was maintained beyond 95％ at every time point in the two groups.Conclusion Intravenous administration of dexmedetomidine can relieve stress response in tracheotomy of neurosurgical patients,and reduce fluctuation of hemodynamic and dysphoria in operation,with no respiratory inhibition.