盐酸右旋美托咪定对脑膜瘤切除术患者围拔管期应激反应的影响

Effect of Dexmedetomidine on the Stress Response in the Period of Tracheal Extubation in Patients Undergoing Meningioma Resection

目的：观察不同剂量的盐酸右旋美托咪定对脑膜瘤切除术患者全麻围拔管期应激反应的影响。方法：60例ASAI～Ⅱ级,年龄25-65岁脑膜瘤切除术患者,随机分为四组,NS、D1、D2和D3组,NS组：静脉泵入等量的生理盐水,D1、D2和D3组静脉泵注负荷量均为0.6μg/kg的盐酸右旋美托咪定,各组泵注时间均为10分钟,输注结束后随之给予维持量,D1组：盐酸右旋美托咪定维持量0.2μg·kg-1·hr-1;D2组：盐酸右旋美托咪定维持量0.4μg·kg-1·hr-1;D3组：盐酸右旋美托咪定维持量0.6μg·kg-1·hr-1。观察并记录拔管时的耐管评分、呛咳程度、警觉/镇静评分（OAA/S）、拔管时间及拔管即刻和拔管后3 min的平均动脉压（MAP）、心率（HR）及恶心、寒战等不良反应。结果：D3组患者耐管评分高于D1组、D2组和NS组,呛咳程度轻于D1组、D2组和NS组（P〈0.05）;D2、D3组患者拔管即刻和拔管后3 min的MDP、HR均明显低于D1组（P〈0.05）;D1、D2和D3组不良反应少于NS组;四组拔管时间无明显差异。结论：盐酸右旋美托咪定降低脑膜瘤切除术患者全麻围拔管期的应激反应,增强患者对气管导管的耐受性。

Objective： To investigate the effect of different doses of dexmedetomidine on the stress response during the period of tracheal extubation for meningioma resection. Methods： Sixty ASAI～Ⅱpatients aged 25-65 yrs undergoing meningioma resection were randomly divided into 4 groups, Group NS, D1, D2 and D3. The patients received similar volumes of saline in Group NS.Dexmedetomidine was given as a bolus dose of 0.6 μg /kg in 10 minutes in Group D1, D2 and D3. A maintenance infusion was given after bolus dose. Group D1 was followed by a maintenance infusion of 0.2 μg·kg-1·hr-1; Group D2 was followed by a maintenance infusion of 0.4 μg·kg-1·hr-1; Group D3 was followed by a maintenance infusion of 0.6 μg·kg-1·hr-1; Tolerance score to endotracheal tube,bucking degree, OAA/S and extubation time were recorded. The MAP and HR at time point of extubation and three minutes after extubation were recorded simultaneously. Adverse effects such as nausea, shiver and so on were also recorded. Results： The tolerance score to endotracheal tube and bucking degree in D3 were significantly superior to those of other groups（P〈0.05）; The MAP and HR in group D3 at time point of extubation and three minutes after extubation were significantly low than those of other groups; Compared with group NS, the adverse effects in group D1, D2 and D3 were decreased; Extubation time in four groups were no difference. Conclusion：Dexmedetomidine could effectively reduce the stress reaction to extubation in patients after general anesthesia undergoing meningioma resection and strengthen the patients＇ tolerance to endotracheal tube.