右美托咪定辅助全麻在肩关节镜手术中的临床应用价值

The clinical value of dexmedetomidine in general anesthesia in arthroscopic shoulder surgery

目的探讨右美托咪定(DEX)辅助全麻在肩关节镜手术中的临床应用价值。方法择期全麻下行肩关节镜手术患者60例,随机分成对照组和DEX组,DEX组在麻醉诱导前20 min静脉泵注0.5μg/kg DEX,维持为0.5μg/(kg·h),直到术毕前20 min,对照组给予等量的生理盐水。观察术前(T0)、插管时(T1)、手术开始30 min(T2)、手术开始60min(T3)、停药时(T4)、手术结束时(T5)、拔管时(T6)、拔管后30 min(T7)、回病房时(T8)的平均动脉压(MAP)和心率(HR),记录术中尿量、冲洗液量、静脉补液量、手术时间、苏醒时间、丙泊酚用量和瑞芬太尼用量等,另外对T7、T8、回病房后2 h(T9)时段进行VAS疼痛评分和Ramsay镇静评分,同时观察苏醒期不良反应发生率情况。结果与对照组相比,DEX组术中和苏醒期MAP和HR有明显降低,血流动力学稳定(P<0.05,P<0.01),且在T1、T6时MAP、HR波动小,应激反应低。DEX组内比较,各时间点与T0比较,MAP、HR明显降低(P<0.05,P<0.01)。两组在T7、T8、T9时段的VAS评分和Ramsay评分差异有统计学意义(P<0.05,P<0.01)。两组术中尿量、冲洗液量、丙泊酚用量、瑞芬太尼用量以及麻醉苏醒时间差异有统计学意义(P<0.05,P<0.01)。DEX组术后躁动、寒战、恶心等不良反应发生率低于对照组(P<0.05,P<0.01),但口干、嗜睡和心动过缓发生率高于对照组(P<0.05,P<0.01)。结论 DEX辅助全麻用于肩关节镜手术是安全、有效、确切的,且苏醒期不良反应少。

Objective To evaluate the clinical value of dexmedetomidine （DEX） in general anesthesia in armro- scopic shoulder surgery. Methods Sixty patients （ASA I ～ Ⅱ ） scheduled for elective arthroscopic shoulder sur- gery under general anesthesia were randomly divided into two groups： DEX group and control group. In group DEX, 0.5 μg/kg of the loading dose DEX was received intravenously by micro-pump within 20 minutes before induction of anesthesia, then 0. 5 μg/（ kg · h） DEX was maintained until 20 mins before the anticipated completion of sur- gery. While in control group,the same volume of normal saline was given by the same way. The MAP and HR be- fore dexmedetomidine or normalsaline infused intravenously （ T0 ）, immediately after intubation （ T1 ） , 30 min after recorded at the time of T7 ,T8,2 hours after returning to the ward （T9）. While the incidence of adverse events was observed during the period of recovery. Results Compared with control group, MAP and HR in group DEX were decreased significantly and maintained stable during the operation and recovery （ P 〈 0. 05, P 〈 0. 01 ）. Further- more, MAP, HR had a small fluctuation and with poor response to stress in group DEX at T1 , T6. Intra-group DEX comparison, compared to T0, the MAP, HR had a measureable reduction （P 〈 0. 05, P 〈 0. 01）. The VAS and Ramesay scores in both groups were statistically significant at T7、T8 （P 〈 0. 05, P 〈 0. 01 ）. Similiarly, the volume of washing fluid, urination, the amount of propofol and remifentanil as well asawakening time had statistical signifi- cance （P 〈0.05, P 〈0.01）. The occurrence rate of adverse reaction such as agitation shivering nausea after sur- gery in group DEX was lower than that in control group （ P 〈 0. 05, P 〈 0. 01 ） , but a higher incidence of dry mouth, drowsiness, bradycardia occurred in group DEX （ P 〈 0. 05, P 〈 0.01 ）. Conclusion Dexmedetomidine in general anesthesia in arthroscopic shoulder surgery is safe and effective, and with less adverse reactions during the recovery.