右美托咪定治疗腹部手术患者苏醒期躁动

The observation of dexmedetomidine in treatment of emergence agitation after abdomen surgery

目的：探讨右美托咪定治疗全麻患者苏醒期躁动的有效性及安全性。方法选择 ASA I ～II级择期腹部手术患者120例，随机双盲分为右美托咪定组（A 组），咪达唑仑组（B 组）和0．9％氯化钠注射液对照组（C 组），每组40例。手术结束前40 min，A 组静脉泵注右美托咪定0．6μg／kg（10 min），B 组和 C 组分别静脉注射咪达唑仑30μg／kg 和0．9％氯化钠注射液1 mL，通过躁动评分、镇静评分、监测拔管前后的血压、心率和脉搏氧饱和度以及拔管时间等指标，评估患者在术后恢复室（PACU）的麻醉复苏情况。结果咪达唑仑组患者麻醉恢复时间[（18．2±1．9）min]、拔管时间[（32．1±3．9）min]和 PACU 停留时间[（48．7±3．1）min]明显长于右美托咪定组[（13．1±2．4）min、（26．5±2．2）min 和（39．8±3．4）min，P ＝0．023、0．040、0．003]和0．9％氯化钠注射液对照组[（12．6±2．3）min、（24．8±2．9）min 和（38．6±4．3）min，P ＝0．017、0．023、0．001）]；右美托咪定组和咪达唑仑组患者的镇静评分[（2．3±0．2）分和（2．4±0．1）分]明显优于0．9％氯化钠注射液对照组[（1．1±0．50）分，P ＝0．025、0．020]；右美托咪定组躁动情况[（1．3±0．5）分]明显优于咪达唑仑组和0．9％氯化钠注射液对照组[（2．5±0．5）分和（2．4±0．6）分，P ＝0．011、P ＝0．020]；在拔管前2 min、拔管即刻和拔管后5 min，右美托咪定组患者心率[（62．7±4．1）次／min、（67．3±3．4）次／min 和（63．2±4．3）次／min]均慢于咪唑安定组[（72．3±3．4）次／min、（84．9±5．3）次／min 和（82．1±3．1）次／min， P ＝0．002、0．001、0．001]和0．9％氯化钠注射液组[（73．6±2．9）次／min、（85．3±4．7）次／min 和（83．3±4．5）次／min，P ＝0．001、0．023、0．038）]；在拔管即刻，右美托咪定组患者平均动脉压[（87．3±4．2）mmHg）]低于咪达唑仑组[（93．1±4．3）mmHg，P ＝0．001]和0．9％氯化钠注射液对照组[（95．6±5．8）mmHg，P ＝0．001]，在拔管后5 min，右美托咪定组和咪达唑仑组患者平均动脉压[（84．5±3．1）mmHg]和[（85．1±2．9）mmHg]均低于0．9％氯化钠注射液对照组[（92．3±4．6）mmHg，P ＝0．023、0．038]。结论右美托咪定是治疗腹部手术患者全麻苏醒期躁动的理想药物，其疗效优于咪达唑仑。

Objective To investigate the efficacy and safety of dexmedetomidine on prevention of emergence agitation in adult patients during recovery period after abdomen surgery.Methods 1 20 ASA I -II patients scheduled for elective abdominal surgery under general anesthesia were randomly divided into three groups：dexmedetomidine group （group A）,midazolam group （group B）and the saline control group （group C）,40 cases in each group.40min before the end of surgery,dexmedetomidine 0.6μg/kg was continued intravenous infusion 1 0min in group A,midazo-lam 30μg/kg and 1 mL physiological saline were respectively intravenously injected in group B and group C.The post-operative recovery room （PACU）of restlessness,sedation,blood pressure,SpO2 and extubation time were observed. Results In of midazolam group,the time of anesthesia recovery[（1 8.2 ±1 .9）min],extubation[（32.1 ±3.9）min] and PACU staying[（48.7 ±3.1 ）min]were significantly longer compared with the dexmedetomidine group[（1 3.1 ± 2.4）min,（26.5 ±2.2）min and （39.8 ±3.4）min,P =0.023,0.040 and 0.003]and the saline group[（1 2.6 ± 2.3）min,（24.8 ±2.9）min and （38.6 ±4.3）min,P =0.01 7,P =0.023 and P =0.001].The postoperative seda-tion scores of dexmedetomidine [（2.3 ±0.2 ）points,P =0.025 ]and midazolam group [（2.4 ±0.1 ）points,P =0.020]were significantly higher than the saline control group[（1 .1 ±0.5）points].The postoperative agitation score of dexmedetomidine （1 .3 ±0.5）points was lower than midazolam group [（2.5 ±0.5）points,P =0.01 1 ]and the saline control group[（2.4 ±0.6）points,P =0.020].HR and MAP of three groups at 2 min before extubation were observed,in the immediate extubation and at 5 min after extubation,the HR of dexmedetomidine group[（62.7 ± 4.1 ）times/min,（67.3 ±3.4）times/min and （63.2 ±4.3）times/min]was significantly delayer than midazolam group [（72.3 ±3.4）times/min,（84.9 ±5.3）times/min and （82.1 ±3.1 ）times/min],（P =0.002,P =0.001 and P =0.001 ）and the saline control group [（73.6 ±2.9 ）times/min,（85.3 ±4.7 ）times/min and （83.3 ± 4.5）times/min],（P =0.001 ,P =0.023 and P =0.038）at the three time.In the immediate extubation,the MAP of patients in dexmedetomidine group[（87.3 ±4.2）mmHg）]was lower than midazolam group[（93.1 ±4.3）mmHg, P =0.001 ]and the saline control group[（95.6 ±5.8）mmHg,P =0.001 ].At 5 min after extubation,the MAP of patients in both of dexmedetomidine[（84.5 ±3.1 ）mmHg）]and midazolam[（85.1 ±2.9）mmHg]group were lower than that in the saline control group[（92.3 ±4.6）mmHg,P =0.023 and P =0.038〗.Conclusion Dexmedetomi-dine could be one of the ideal drug to relieve emergence agitation in adult patients during recovery period after abdo-men surgery and the curative effect is better than midazolam.