盐酸右美托咪定预防麻醉后监测治疗室患者气管拔管反应的效果

Effects of dexmedetomidine on attenuating the responses to tracheal extubation of post anesthesia care unit patients

目的探讨盐酸右美托咪定（DEX）用于预防麻醉后监测治疗室（PACU）患者气管拔管心血管不良反应的可行性。方法选择行气管内插管全身麻醉手术后送入PACU的患者120例，年龄18～68岁，美国麻醉医师协会分级Ⅰ或Ⅱ级。随机将患者分入DEX组和对照组，每组60例。两组均采用相同的麻醉诱导和维持方法，手术结束均转入PACU，连接呼吸机维持呼吸。待患者出现自主呼吸、呼之能应后，DEX组将DEX 0．4μg／kg稀释至20mL，以微量输液泵静脉注射，注射时间10min；对照组经微量输液泵注射等量0．9％氯化钠溶液。在用药前、用药后、气管拔管前、气管拔管即刻，以及气管拔管后5、10min各时间点观察并记录患者的收缩压（SBP）、舒张压（DBP）、心率（HR）、脉搏血氧饱和度（SpO2）和Robertson意识评分，观察气管拔管时呛咳、气管拔管后躁动等不良反应发生情况。结果DEX组用药后SBP、DBP、HR均显著低于同组用药前（P值分别〈0．05、0．01）；气管拔管后即刻，以及气管拔管后5和10min的SBP、DBP、HR与同组用药前和气管拔管前的差异均无统计学意义（P值均〉0．05）。对照组用药前后SBP、DBP、HR的差异均无统计学意义（P值均〉0．05）；气管拔管后即刻和拔管后5min的SBP、DBP、HR均显著高于同组用药前和气管拔管前（P值分别〈0．05、0．01）。对照组用药后、气管拔管前、气管拔管后即刻，以及气管拔管后5min的SBP、DBP、HR均显著高于DEX组同时间点（P值分别〈0．05、0．01）。两组间各时间点的SpO2和Robertson意识评分，以及气管拔管时间的差异均无统计学意义（P值均〉0．05）。DEX组气管拔管时呛咳和气管拔管后躁动的发生率均显著低于对照组（P值均〈0．01）。结论DEX可有效预防PACU患者气管拔管时的心血管不良反应发生，并能减少气管拔管时呛咳和躁动的发生。

Objective To evaluate the feasibility of dexmedetomidine for inhibiting the cardiovascular response to endotracheal intubation in the post anesthesia care unit （PACU）. Methods A total of 120 patients, American Society of Anesthesiologists （ASA） physical status Ⅰ or Ⅱ, aged 18 - 68 years, receiving general anesthesia, were randomly assigned to two groups （n = 60）： test group and control group. The anesthesia was induced and maintained with the same methods in both groups. After operation all patients were transferred to the PACU and were mechanically ventilated. When the patients could respire spontaneously and respond to verbal instructions, 0.4 μg/kg dexmedetomidine C20 mL） was injected by microinfusion pump within 10 min in the test group, and equal amounts of normal saline was given in the control group. Systolic blood pressure （SBP）, diastolic blood pressure （DBP）, heart rate （HR）, pulse oxygen saturation （SpO2） and Robertson score were recorded before infusion of dexmedetomidine, after infusion of dexmedetomidine, before extubation, immediately after extubation and at 5 and 10 min after extubation. Adverse reaction, such as agitation and cough were observed at extubation. Results Compared with those in the control group, SBP, DBP and HR were significantly decreased after injection of dexmedetomidine in the test group （all P〈0. 05, 0.01）3 however, the variables immediately after extubation, 5 min after extubation were not significantly different from those before injection of dexmedetomidine or before extubation （all P〉0. 05）. There were no significant differences in terms of SBP, DBP or HR in the control group before and after injection of dexmedetomidine （all P〉0. 05）, while the parameters immediately after extubation, 5 min after extubation were significantly higher than those before infusion of dexmedetomidine and before extubation （ P〈 0. 05, 0. 01 ）. SBP, DBP and HR in the control group were significantly higher than those in the dexmedetomidine group after infusion of dexmedetomidine, before extubation, immediately after extubation, and 5 min after extubation （P〈0.05, 0.01）. There were no significant differences in SpO2, Robertson score or extubation time between two groups （all P〉0.05）. The incidences of agitation and cough during extubation in the dexmedetomidine group were significantly lower than those in the control group （both P〈0.01）. Conclusion Dexmedetomidine can effectively prevent cardiovascular side effects and reduce the incidence of agitation and cough in patients in the PACU during extubation.