术中使用右美托咪定对肺叶切除患者全麻苏醒期的影响

Intraoperative Dexmedetomidine Reduces Postoperative Analgesia in Adults after Lobectomy

目的探讨术中使用右美托嘧定(dexmedetomidine,DEX)对开胸肺叶切除手术患者全麻苏醒期的影响.方法 50例开胸手术患者随机分为2组:对照组(A组,25例)和右美托嘧啶组(B组,25例).所有组患者以丙泊酚、瑞芬太尼等麻醉诱导及维持,B组患者于麻醉前10 min持续泵注右美托嘧啶1μg/kg(10 min)继以0.3μg/(kg.h)至手术结束前10 min.患者呼吸恢复后带管进入术后恢复室(PACU).记录患者入室后(P1)、拔管前(P2)、拔管后(P3)、拔管后30 min(P4)、拔管后1 h(P5)平均动脉压(MAP)、心率(HR)、动脉血氧分压(Pa O2)、脑电双频指数(bispectral index,BIS)、呼吸频率(f)及潮气量(TV);记录拔管前镇静躁动评分(sedation-agitation scale SAS)、苏醒时间及PACU驻留时间;记录拔管后、拔管后30 min及1 h VAS评分及芬太尼使用人次数.结果 (1)B组患者入室后、拔管前及拔管后MAP及HR均明显低于A组(P<0.05,P<0.01);(2)B组入室后BIS值明显低于A组(P<0.05);B组入室后、拔管前及拔管后TV均明显高于A组(P<0.05),入室后及拔管前f明显低于A组(P<0.05);B组患者入室后及拔管后的Pa O2明显高于A组(P<0.05);(3)与A组相比,B组患者SAS评分明显降低(P<0.05);(4)B组患者拔管后及拔管后30 min的VAS评分明显低于A组(P<0.05),B组拔管后30 min及拔管后1 h使用芬太尼的人数均明显低于A组(P<0.05,P<0.01).结论右美托咪定可以明显降低开胸手术患者苏醒期血压及心率,改善苏醒期通气,减轻术后疼痛并减少术后躁动.

Objective To evalute the effects of intraoperative dexmedetomidine in adult patients during recovery periods from general anesthesia after lobectomy. Methods Fifty adult patients undergoing lobectomy were randomized into two groups： control group（Group A,n=25） and dexmedetomidine group（Group B,n=25）.No differences in baseline characteristics were observed between the groups. All patients were given propofol and remifentanil for anesthetic induction and maintenance. Ten minutes before the anestheia, patients were given dexmedetomidine（1 μg/kg over 10 minutes followed by a continuous infusion of 0.3 μg/kg/h throughout surgery until 10 minutes before the end of operation） or comparable volumes of saline as a placebo. After the surgery, all patients were sent to the post- anesthetic care unit（PACU） with intubation. The parameters including mean arterial pressure（MAP）,heart rate（HR）,arterial oxygen pressure（Pa O2）,bispectral index（BIS）,respiratory rate（f）,tidal volume（TV）,sedation- agitation score（SAS）,recovery time,and the stay of PACU were recorded.The times of requiring fentanyl and the VAS score were recorded too.Results（1） The MAP and HR in the group B was significantly lower in group B than that in group A（P〈0.05）.（2） The BIS and f in the group B wassignificantly lower in group B than that in group A（P〈0.05）, and the TV and PaO 2in group B was significantly higher than that in group A（P〈0.05）（3） The SAS score decreased in the group B compared with the group A（P〈0.05）.（4） The VAS score was significantly lower in group B than that in group A（P〈0.05）, and in the group B, less patients needed fentanyl after extubation（ P〈0.05）. Conclusions Intraoperative dexmedetomidine administration can significantly reduce the blood pressure and heart rate in patients undergoing thoracic surgery, improve ventilation during recovery,and decrease the occurrence of agitation and postoperative analgesia during analepsia.