小剂量右美托咪定对高血压全麻患者苏醒质量和心血管反应的影响

Influence of low doses of dexmedetomidine on quality of cognitive recovery and cardiovascular response in hypertensive patients during extubation after general anesthesia

目的探讨小剂量右美托咪定（Dex）对高血压全麻患者苏醒质量和心血管反应的影响。方法80例ASAI或Ⅱ级拟行腹腔镜胆囊切除术高血压患者，随机分为Dex组（D组）和对照组（C组），每组40例。D组于麻醉诱导前15min给予Dex负荷剂量0．6μg／kg，术中以小剂量0．3μg／（kg·h）维持静脉泵注至手术结束前30min，C组则静脉泵注相同剂量的生理盐水。记录两组患者呼吸恢复时间、拔管时间、定向力恢复时间、Ramsay镇静评分、VAS镇痛评分和不良反应发生率及拔管前（T_0）、拔管时（T_1）、拔管后5min（T2）、15min（T3）、30min（T4）BP、HR和Sp02的变化。结果两组患者的呼吸恢复时间、拔管时间、定向力恢复时间比较差异无统计学意义（P〉0．05），D组拔管后各时点Ramsay镇静评分高于C组、VAS镇痛评分低于C组，比较差异有统计学意义（P〈0．05），与C组比较，D组拔管期不良反应明显减少（P〈0．05），心血管反应明显减轻（P〈0．05）；与拔管前比较，C组拔管时、拔管后血压明显升高（P〈0．05）。结论小剂量右美托咪定可有效地改善高血压患者全麻拔管期苏醒质量，并明显减轻心血管反应。

Objectives To investigate the influence of low doses dexmedetomidine on the quality of cognitive recovery and cardiovascular response in hypertensive patients during extubation after general anesthesia. Methods 80 hypertensive patients （ ASA I-Ⅱ ） scheduled for laparoscopic eholecystectomy were randomly divided into a Dex group （group D） and a control group（group C）, 40 for each group. Group D were given dexmedetomidine with a loading dose of 0.6 μ g/kg 15 min before the induction intravenously and maintained the operation with a low dose of 0.3 μ g/（kg · h） until 30 min before the end of the operation. Group C were given saline of the same dose intravenously. The breathing recovery time, the extubation time, the cognitive recovery time, the Ramsay sedation score, the Visual Analogue Scale, and the incidence of adverse reactions （cough, restlessness, chills, nausea and vomiting, dizziness and headache, etc.） of both groups were recorded; the changes of hemodynamic parameters such as arterial blood pressure （BP）, heart rate （HR）, and pulse oxygen saturation （SpO2） of all the patients 30 mins before extubation （To）, at extubation （T1）, 5 mins after extuhation （T2）, 15 rains after extubation （T3）, and 30 mins after extubation （T4） were monitored. Results There were no statistical differences in breathing recovery time, extubation time, and cognitive recovery time between these two groups （P 〉 0.05）. compared with Group C, The Ramsay sedation score was higher, the Visual Analogue Scale and the incidence of adverse reactions were lower, and the cardiovascular responses were significantly fewer in group D than in group C （P 〈 0.05）. The arterial blood pressure（BP） were significantly higher at T1, T2, T3, and T4 than at TO in group C （P 〈 0.05）. Conclusions Low doses of dexmedetomidine can effectively improve the quality of cognitive recovery in hypertensive patients during extubation after general anesthesia and significantly attenuate the cardiovascular response.