右美托咪定对腹腔镜下全子宫切除术患者全麻气管拔管期心血管反应的影响

Effects of Dexmedetomidine on Cardiovascular Responses to Tracheal Extubation after General Anesthesia for Laparoscopic Panhysterectomy

目的：观察右美托咪定（dexmedetomidine，DEX）对腹腔镜下全子宫切除术患者全麻气管拔管期心血管应激反应及苏醒的影响。方法：将60例择期行腹腔镜下全子宫切除术患者（ASAⅠ～Ⅱ级）随机分为DEX组和对照组，每组30例。气管拔管前10min，DEX组静脉滴注DEX0．3μg／kg；对照组静脉滴注0．9％氯化钠液10mL。观察麻醉前、气管拔管前（1min）、气管拔管时、气管拔管后（1min、5min、10min）的平均动脉压（mean arterial pressure，MAP）、心率（heartrate，HR）；比较2组患者自主呼吸恢复时间、苏醒时间、气管拔管时间以及气管拔管期不良反应。结果：对照组MAP和HR在气管拔管前、气管拔管时均升高，且明显高于同期DEX组（P〈0．05）；DEX组MAP和HR在气管拔管后5min、10min时均下降，且明显低于同期对照组（P〈0．05）。DEX组MAP和HR在气管拔管前、气管拔管时及气管拔管后1min与麻醉前比较，差异无统计学意义（P〉0．05）。两组患者呼吸恢复时间、苏醒时间、气管拔管时间差异无统计学意义（P〈0．05）；DEX组气管拔管期不良反应率明显低于对照组（P〈0．05）。结论：DEX能有效抑制腹腔镜下全子宫切除术患者气管拔管期的心血管应激反应，而且对患者的苏醒和气管拔管时间影响甚少。

Objective：To investigate the effects of dexmedetomidine （DEX） on cardiovascular responses to tracheal extubation in patients undergoing general anesthesia for laparoscopic panhysterectomy. Methods：A total of 60 ASA physical status Ⅰ-Ⅱ patients who underwent general anesthesia for laparoscopic panhysterectomy were randomly allocated to DEX group or control group, with 30 cases in each group. At 10 rain before the end of surgery, 0.3μg/kg DEX was intravenously infused in DEX group, while 10 mL 0. 9% sodium chloride solution was intravenously infused in the control group. Mean arterial pressure （MAP） and heart rate （HR） were recorded before operation, at 1 min before extubation, at extubation and at 1 min, 5 min, 10 min after extubation, respectively. Results： MAP and HR in the control group significantly increased at extubation and 1 min before extubation compared with the baseline value, and they were significantly higher than those in DEX group in the corresponding period （P〈0.05）. MAP and HR significantly decreased at 5 rain and 10 min after extubation in DEX group, and they were significantly lower than those in the control group in the corresponding period （P〈0.05）. No statistically significant differences in MAP and HR were found in DEX group at 1 min before extubation, at extubation and at 1 min after extubation, compared with the baseline values （P〈0.05）. There were no statistical differences between the two groups with respect to the breathing recovery time, eye opening time and tracheal extubation time （P〈0. 05）. The incidence of adverse reaction was lower in DEX group than that in control group （P〈0.05）. Conclusions： DEX administration may effectively attenuate cardiovascular responses to tracheal extubation in patients undergoing laparoscopic panhysterectomy, without influence on recovery time.