右美托嘧啶影响黄疸患者全身麻醉苏醒质量的研究

The influence of dexmedetomidine on the anesthesia recovery quality in patients with obstructive jaundice

目的探讨右美托嘧啶对黄疸患者全身麻醉苏醒质量的影响。方法选取肝胆外科需做胆道探查手术的黄疸患者40例,采用双盲研究随机分为右美托嘧啶组(D组)和对照组(C组)各20例,所有患者均采用静吸复合麻醉,其中D组在麻醉诱导前15 min开始以0.5μg/kg负荷量泵注右美托嘧啶,术中以0.008μg/(kg·min)至缝皮前10 min结束,C组注等量生理盐水。记录两组肌松药总量、拮抗剂用量、停药后麻醉苏醒时间以及拔管期间的血压、心率的变化幅度,并比较苏醒期并发症的发生率。记录麻醉诱导前未给予右美托嘧啶或生理盐水时(M1)、插管后5 min(M2)、切皮后10 min(M3)、拔管后10min(M4)各时点去甲肾上腺素的血浆浓度。结果两组呼吸恢复时间、拔管时间、定向力恢复时间比较差异均无统计学意义(P>0.05);D组患者苏醒过程中血压变化幅度明显小于C组患者,差异有统计学意义(P<0.05)。C组M3和M4时点的去甲肾上腺素水平较M1时增高,差异有统计学意义(P<0.05);D组以上指标相应时点与M1比较无明显变化。与C组比较,D组寒战和烦躁发生率较低,但心率变缓(<60次/分钟)的发生率较高(P<0.05)。结论右美托嘧啶用于黄疸患者的麻醉不仅不影响苏醒时间,还使血流动力学更加稳定,降低了术后烦躁和寒战的发生率。

Objective To investigate the influence of dexmedetomidine（DEX）on quality of anesthesia recover in patients with obstructive jaundice（OJ）. Methods Forty patients with OJ who needed bile duct exploration were double-blind randomly divided into DEX and control groups,20 in each group. All patients were anesthetized with combined intravenous and inhalational techniques. The patients in the DEX group received intravenous DEX infusion with a load dosage of 0. 5 μg/kg for 15 min before anesthesia induction. Then,intravenous DEX was continuously infused at a speed of 0. 008 μg/（ kg · min） during the operation until 10 min before suture skin. Patients of the control group received intravenous normal saline infusion in the same way. The dosage of muscle relaxant and antagonist, anesthesia recovery time, blood pressure and heart rate before and after awakening extubation process,incidence of irritabihty and shivering in the recovery period were compared. Serum norepinephrine （NE）concentrations were measured before （ML ）DEX or saline infusion,5 rain after intubation（ M2 ）, 10 min after cutting skin（ M3 ）, and 10 min after extubation. Results There is no differences between the two groups in the respiratory recovery time, orientation recovery time, awaking extubation time. However, the changes of blood pressure in the DEX group were smaller than that in the control group during the awaking process（P 〈 0. 05）. The changes of plasma levels of NE in the control group at the times of M3 and M4 were bigger than that of M1 （P 〈 0. 05）. There was less irritability and shivering in the recovery period in the DEX group than that in the control group （P 〈 0. 05）. Conclusion DEX can not only be used safely to the patients with OJ, but also keep the hemodynamic stable during the process of extubation. Meanwhile,it can reduce the incidence of postoperative irritability and shivering.