右美托咪定在预防腹腔镜阑尾切除术麻醉复苏期躁动中的应用价值

Dexmedetomidine in the prevention of agitation during anaesthesia resuscitation of laparoscopic appendectomy

目的观察右美托咪定在腹腔镜阑尾切除术中预防患者麻醉苏醒期躁动的临床应用价值。方法回顾性分析2016年1月至2017年12月行全麻腹腔镜阑尾切除术60例患者的临床资料。根据麻醉前是否给予右美托咪定分为观察组(n=30)和对照组(n=30)。比较两组手术结束后(T1)、气管导管拔除时(T2)和气管拔管后5 min(T3)的平均动脉压(MAP)、心率(HR)变化情况,观察两组恢复时间、拔管时间及躁动发生率。结果在T1、T2和T3时,观察组的MAP和HR均显著低于对照组(P<0. 05)。观察组T2和T3的MAP、HR与T1比较均无显著差异(P>0. 05),但对照组T2、T3的MAP及HR明显高于T1(P<0. 05)。观察组苏醒时间为(10. 4±2. 1) min,对照组为(9. 5±1. 6) min,两组间差异不明显(t=1. 87,P=0. 07);观察组拔管时间为(15. 9±5. 7) min,对照组为(14. 8±5. 1)min,两组间差异不明显(t=0. 79,P=0. 43)。观察组拔管前1分钟(T4)的躁动发生率低于对照组(3. 3%vs23. 3%,P<0. 05)。结论右美托咪定用于腹腔镜阑尾切除术安全、有效,可减少患者躁动的发生率。

Objective To observe the clinical value of dexmedetomidine in laparoscopic appendectomy for preventing agitation during anesthesia recovery period. Methods The clinical data of 60 patients undergoing laparoscopic appendectomy under general anesthesia were retrospectively analyzed. The patients were divided into observation group with dexmedetomidine before anesthesia and control group without dexmedetomidine before anesthesia( n = 30,each). The changes of mean arterial pressure( MAP) and heart rate( HR) at the end of operation( T1),at the time of tracheal catheter extraction( T2) and 5 minutes after tracheal extubation( T3) were compared between two groups. The recovery time,extubation time and incidence of restlessness were observed too. Results At T1,T2 and T3,MAP and HR in observation group were significantly lower than those in control group( all P<0. 05). There were no significant differences in MAP and HR between T2,T3 and T1 in observation group( all P > 0. 05),but MAP and HR at T2 and T3 were significantly higher than those at T1 in control group( all P<0. 05). The wake-up time was( 10. 4±2. 1) min in observation group and( 9. 5 ± 1. 6) min in control group,and there was no significant difference between two groups( t = 1. 87,P =0. 07). There was no significant difference in extubation time between two groups[( 15. 9±5. 7) min vs( 14. 8±5. 1) min,t =0. 79,P = 0. 43]. The incidences of restlessness at 1 minute before extubation( T4) in observation group were statistically lower than those in control group( 3. 3% vs 23. 3%,P < 0. 05). Conclusion The application of dexmedetomidine in laparoscopic appendectomy is safe and effective and can reduce the incidence of agitation in the patients.