右美托咪定对开腹术患者七氟醚复合麻醉恢复质量的影响

Effect of dexmedetomidine on quality of recovery from sevoflurane-based anesthesia in patients undergoing abdominal surgery

目的评价右美托咪定对开腹术患者七氟醚复合麻醉恢复质量的影响。方法择期行开腹术患者80例，年龄30～64岁，体重45～80kg，性别不限，ASA分级I或Ⅱ级，采用随机数字表法，将其分为2组（n=40）：对照组（C组）和右美托咪定组（D组）。常规麻醉诱导气管插管后行机械通气，麻醉维持：吸入七氟醚，间断静脉注射舒芬太尼和顺苯磺酸阿曲库铵，维持BIS值45～60。常规麻醉诱导后，D组经15min静脉输注右美托咪定1μg／kg，随后以0．6μg·kg-1·h-1。速率输注至手术结束前30min。分别于术毕、拔除气管导管前1min、拔除气管导管后1rain时记录HR和MAP；记录苏醒时间、拔除气管导管时间；记录拔除气管导管时呛咳、麻醉恢复期恶心呕吐、呼吸抑制和躁动的发生情况。结果与C组比较，D组拔除气管导管前1min和拔除气管导管后1min时MAP和HR降低，苏醒时间和拔除气管导管时间缩短，呛咳、恶心呕吐和躁动的发生率降低（P〈0．05），呼吸抑制发生率差异无统计学意义（P〉0．05）。结论常规麻醉诱导后静脉输注右美托咪定1μg／kg，随后以O．6μg·kg-1·h-1速率输注至手术结束前30min可明显提高开腹术患者七氟醚复合麻醉恢复质量。

Objective To evaluate the effect of dexmedetomidine on the quality of recovery from sevoflurane-based anesthesia in the patients undergoing abdominal surgery. Methods Eighty patients of both sexes, aged 30-64 yr, weighing 45- 80 kg, with American Society of Anesthesiologists physical status I or II , scheduled for elective abdominal surgery, were randomly assigned into 2 groups （n = 40 each） using a random number table： control group （ group C） and dexmedetomidine group （ group D）. After routine induction of anesthesia, all the patients were tracheally intnbated, and mechanically ventilated. Anesthesia was maintained with sevoflurane inhalation and intermittent iv boluses of sufentanil and cisatracurium besylate, and bispectral index values were maintained at 45- 60. After induction of anesthesia, dexmedetomidine was infused in a dose of 1 μg/kg over 15 min, followed by a continuous infusion of 0.6 μg·kg-1·h-1 until 30 min before the end of surgery in group D. Group C received normal saline instead. Heart rate （HR） and mean arterial pressure （MAP） were recorded at the end of surgery, and at 1 min before and after extubation. The emergence time, extubation time, and occurrence of bucking during extubation, and nausea and vomiting, respiratory depression, and agitation during recovery from anesthesia were recorded. Results Compared with group C, MAP and HR were significantly decreased at 1 min before and after extubation, the emergence time and extubation time were shortened, the incidence of bucking, nausea and vomiting, and agitation was decreased, and no significant change was found in the incidence of respiratory depression in group D. Conclusion Dexmedetomidine infused in a dose of 1μg/kg after routine induction of anesthesia, followed by a continuous infusion of 0.6 μg·kg-1·h-1 until 30 min before the end of surgery, can significantly increase the quality of recovery from sevoflurane-based anesthesia in the patients undergoing abdominal surgery.