压力支持通气模式联合右美托咪定用于气管内插管患者苏醒期的效果

Effect of Pressure Support Ventilation combined with Dexmedetomidine on Recovery Period in Endotracheally Intubated Patients

目的:探讨压力支持通气(PSV)呼吸模式联合右美托咪定对气管内插管患者苏醒期的影响。方法:选择因乳腺癌改良根治手术而行气管内插管全麻的患者40例,ASAⅠ-Ⅱ级,随机分成C、D两组各20例,两组在整个麻醉及手术过程中机械通气的模式均持续采用容量控制通气(VCV),持续至气管导管拔出,C组在手术结束前约30 min静脉注射0.9%生理盐水;D组术毕患者有自主呼吸时采用PSV呼吸模式持续至气管导管拔出,D组在手术结束前约30 min静脉注射右美托咪啶0.5μg/kg。记录手术结束后呼之睁眼时间及拔管时间,记录气管导管拔管时Riker镇静、躁动评分及Ramsay镇静评分,记录入室基础值(T0)、拔管即刻(T1)、拔管后2 min(T2)、5 min(T3)、10 min(T4)各时点患者的平均动脉压、心率。结果:与C组比较,D组呼之睁眼时间及拔管时间差异均无统计学意义(P>0.05);D组的躁动发生率明显降低(P<0.01),D组患者Ramsay镇静评分2-4分;D组内T0至T4各时间点心率、血压无明显变化。结论 :联合使用PSV呼吸模式与右美托咪定既可防治气管内插管患者苏醒期躁动及心血管不良反应,又不延迟苏醒。

Objective：To evaluate the efficacy of pressure support ventilation（PSV） combined with dexmedetomidine on recovery period in endotracheally intubated patients. Methods：40 ASA physical status I orⅡ patients undergoing modified radical mastectomy under endotracheal general anesthesia were randomly assigned into group C （n=20） and group D（n=20）. In group C, volume control ventilation（VCV） was used during operation until extubation and 0.9%normal saline was injected intravenously 30min before the end of operation. In group D, VCV was used during operation then transferred to PSV when spontaneous breath appeared and dexmedetomidine was injected intravenously 30 min before the end of operation. The time of opening eyes after operation and extubation time were recorded. Riker sedation-agitation scale and Ramsay sedation scale were recorded at the time of extubation. MAP and HR were recorded at the time of extubation （T1）, 2min after extubation （T2）, 5min after extubation （T3）, 10min after extubation （T4）. Results： Compared with group C,there were no significant differences in the time of opening eyes after operation and extubation time in group D （P〉0.05）. The score of Riker sedation-agitation scale in most patients in group C was 5 at the time of extubation with fast HR and high MAP. Compared with group C,the incidence ofagitation was significantly decreased in group D （P〈0.01）, and cardiovascular adverse reactions significantly decreased at T1-4. The score of Ramsay sedation scale was 2-4 in group D. There were no significant differences in HR and MAP in intra-group D comparison during T0-4 （P〉0.05）. Conclusion：PSV combined with dexmedetomidine can prevent cardiovascular adverse reactions and agitation caused by the endotracheal tube during recovery period in endotracheally intubated patients without delayed awakening.