右美托咪定对丙泊酚-瑞芬太尼麻醉下脊柱侧弯矫形术术中唤醒效果的影响

Effect of dexmedetomidine on awareness during intraoperative wake-up tests in patients undergoing spinal surgery under propofol-remifentanil anesthesia

目的评价右美托咪定对丙泊酚-瑞芬太尼麻醉下脊柱侧弯矫形术术中唤醒效果的影响。方法择期行脊柱侧弯矫形术患者36例,分为右美托咪定组(D组)和生理盐水组(C组),分别在麻醉诱导前给予1μg/kg右美托咪定和等量生理盐水,10min内输完。术中D组持续泵入右美托咪定0.2μg·kg-1·h-1,C组泵入生理盐水。每组18例。观察麻醉诱导前10min(T1)、麻醉诱导后3min(T2)、停药即刻(T3)、唤醒即刻(T4)以及加深麻醉后5min(T5)的平均动脉压(MAP)、心率(HR)。记录两组血流动力学变化情况、苏醒时间、唤醒成功率、唤醒期间的躁动情况及唤醒期间血管活性药的用量。结果两组唤醒成功率相似,D组唤醒时间稍长但无统计学意义(P>0.05),躁动发生率及唤醒期间血管活性药的用量D组显著低于C组(P<0.05)。结论右美托咪定辅助丙泊酚-瑞芬太尼麻醉能有效实施术中唤醒,唤醒期间血流动力学更平稳,不良事件发生率更低。

Objective To investigate the effect of dexmedetomidine on awareness during intraoperative Wake-up tests in patients undergoing spinal surgery under propofol-remifentanil anesthesia .Methods 36 patients ,requiring intraoperative arousal test during posterior spinal surgery were randomly divided into the group D （DEX ,n= 18） and C （NS ,n= 18） .DEX 1 μg/kg followed by 0 .2 μg · kg -1 · h-1 and equal volume NS were infused respectively 10 min before anesthesia induction and maintenance of anesthe-sia in two groups .Hemodynamic parameters were monitored 5 min（T1） before anesthesia induction ,3 min（T2）after anesthesia in-duction ,at the beginning of wake-up test（T3） ,at the end of the test（T4） and 5 min（T5） after deepen anesthesia respectively . Meanwhile the wake-up time ,success rate of arousal ,incidence agitation and the dosage of nitroglycerin during wake-up were also recorded .Results Successive rate of arousal awakening time between two group had no statistically significance （P〉0 .05） .less in-cidence of agitation was found in group D compared with group C ,the dosage of nitroglycerin used during wake-up in group D was less than that in group C（P〈0 .05） .Conclusion Dexmedetomidine auxiliary propofol remifentanil anesthesia can effectively implement intraoperative wake up ,during the awakening the hemodynamic was more smoothly ,and it has lower incidence of adverse events .