不同时机停用右美托咪啶对全身麻醉患者苏醒的影响

Effect of different withdrawal time of dexmedetomidine on the quality of general anesthesia recovery

目的 探讨不同时机停用右美托咪啶对全身麻醉患者苏醒的影响.方法 选择淋巴外科手术患者80例（ASAⅠ～Ⅱ级）,按随机数表法分为实验D1、D2、D3组及C组,D1、D2、D3组于诱导前泵注右美托咪啶0.5μg/kg后,以0.5μg/（kg·h）速率持续输注,分别于术毕前lh、术毕前30 min、术毕停药,对照组持续泵注等量生理盐水.观察患者拔管期间的血流动力学变化,记录所有患者术后自主呼吸恢复时间、睁眼时间、拔管时间、定向力恢复时间、苏醒期意识状态评分（OAA/S）、躁动评分、术后2h内VAS评分最大值及镇痛药使用情况和术中丙泊酚、瑞芬太尼总用量等.结果 拔管期间各时点,D2、D3组平均动脉压（MAP）、心率（HR）与术前比较均差异无统计学意义,但与同时点C组比较,则显著降低,差异有统计学意义（P＜0.05）;C组和D1组拔管时、拔管后5 min MAP、HR明显高于术前,差异有统计学意义（P＜0.05）.自主呼吸恢复时间、睁眼时间、拔管时间、定向力恢复时间,D3组与C组比较均明显延长,差异有统计学意义（P＜0.05）,D1、D2组与C组相比差异无统计学意义.D3组拔管时OAA/S评分低于C组（P＜0.05）.躁动发生率、术后2h内VAS评分最大值和镇痛药使用例数,D2、D3组均明显低于C组和D1组,差异有统计学意义（P＜0.05）.与C组相比,D2、D3组术中丙泊酚、瑞芬太尼的用量明显减少,差异有统计学意义（P＜0.05）.结论 持续泵注右美托咪啶辅助全身麻醉,术毕前30 min停药,既不延长苏醒时间,又可改善患者苏醒质量,延长术后镇痛时间,提高了患者术后舒适度.

Objective To explore effect of different withdrawal time of dexmedetomidine （DEX） on the quality of general anesthesia recovery.Methods Eighty patients of ASA Ⅰ or Ⅱ undergoing lymph surgery were randomly assigned to four groups （n =20）.Groups D1,D2 and D3 received DEX 0.5 μg/kg as bolus before induction,continued with 0.5 μg/（kg · h） by infusion until one hour,30 min before the end of operation and the end of operation,respectively.Group C received equal volume of normal saline.Mean artery pressure （MAP）,heart rate （HR） and pulse oxygen saturation （SpO2） were observed during and after operation.Spontaneous respiration recovery time,eyes open time,extubation time,orientation recovery time,observer＇s assessment of alertness/sedation score （OAA/S）,restlessness score （RS）,and visual analogue scales （VAS） were observed after operation.Results For MAP and HR in Groups D2 and D3,there were no statistically significant difference during extubation compared to those at preoperation,but at the same time point,they were lower than those in group C （P ＜ 0.05）.For groups C and D1,MAP and HR at extubation and 5 min after extubation were higher than those at preoperation （P ＜0.05）.Spontaneous respiration recovery time,eyes open time,extubation time,orientation recovery time in group D3 were significantly longer than those in Group C （P ＜ 0.05）,while there were no statistically significantly difference between groups D1,D2,and group C.OAA/S in group D3 was significantly lower than that in group C （P ＜ 0.05） at extubation.Incidence of restlessness,VAS,and cases given analgesic 2 hours after operation in groups D2 and D3 were significantly lower than those in groups C and D1.Compared to those in group C,dosages of propofol and remifentanil in groups D2 and D3 were significantly lower.Conclusions Dexmedetomidine administered of 0.5 μg/kg before induction,continued with infusion of 0.5 μg/（kg · h） until 30 min before the end of operation,may improve emergence,without influencing the awakening time of patients,and prolong the duration time of analgesia which comfort the patients.