右美托咪定预防全麻下后路减压椎间植骨融合术后寒战的临床研究

A Clinical Study on the Preventive Effect of Dexmedetomidine on the Postoperative Shivering in Patients Undergoing Posterior Lumbar Interbody Fusion

目的:观察右美托咪定对全麻下后路减压椎间植骨融合术(PLIF)后寒战的预防效果。方法:选择行全身麻醉的PLIF手术患者80例,并将其随机分为高剂量右美托咪定组(HD组)、中剂量右美托咪定组(MD组)、低剂量右美托咪定组(LD组)和对照组(C组),每组20例患者。HD组、MD组及LD组在麻醉诱导后分别以0.8、0.5及0.2μg/kg/h静脉泵注右美托咪定至手术结束前40 min;C组泵注生理盐水。监测并记录患者麻醉前的基础体温值及BIS值,送入恢复室即刻、20 min、40 min、60 min的Ramsay镇静评分值、体温值;记录各组手术时长、拔管时间、术中输液量及失血量以及心动过缓、恶心、呕吐等不良反应的发生情况和苏醒期各组寒战程度分级及发生情况。结果:各组患者手术结束时的体温均较基础体温明显降低(P<0.05)。入恢复室后,HD组同一时段的Ramsay镇静评分显著高于其他三组(P<0.01)。HD组的拔管时间明显延长(P<0.01)。与C组比较,MD组及HD组术后心动过缓、口干的发生率明显升高(P<0.05),而恶心、呕吐及呛咳的发生率明显降低(P<0.05)。在恢复室观察期间,MD组及HD组寒战的发生率较C组明显降低(P<0.01);MD组寒战发生率也明显低于LD组(P<0.05)。结论:0.5μg/kg/h持续泵注右美托咪定可以有效预防全麻下PLIF手术术后寒战的发生。

Objective： To observe the preventive effect of dexmedetomidine on the postoperative shivering in patients undergoing general anesthesia after posterior lumbar interbody fusion. Methods： Eighty patients scheduled for posterior lumbar interbody fusion were randomly assigned into four groups. After the induction of anesthesia, group HD, group MD and group LD respectively received intravenous infusion of 0.8 ~g/kg/h, 0.5 p^g/kg/h and 0.2 p^g/kg/h dexmedetomidine until 40 min before the end of operation, while group C received normal saline infusion. Basal temperatures and values of BIS before anesthesia were monitored and recorded. Ramsay sedation scores and temperatures were recorded after the patients were sent to the recovery room immediately, 20 min, 40 rain and 60 min. The operation time, extubation time, intraoperative transfusion volume and incidence rates of adverse reaction were recorded. The grades of shivering and incidence rates of shivering of the four groups were also recorded. Results： The temperatures at the end of operation in each group were lower than the basal temperatures （P〈0.05）. In the recovery room, Ramsay sedation scores of group HD were higher than the other three groups （P〈0.01）. The extubation time of group HD was longer than the other three groups （P〈0.01）. The incidence rates of bradycardia and dry mouth of group MD and HI） were increased than group C （P〈0.05）, and incidence rates of nausea, vomit and cough were decreased tl？an group C （P〈0.05）. The incidence rates of shivering of group MD and HD were decreased than group C （P〈0.01）, and group MD＇was also decreased than group LD （P〈0.05）. Conclusions： Intraoperative infusion with 0.5 μg/kg/h dexmedetomidine could be effective in preventing the postoperative shivering in patients undergoing posterior lumbar interbody fusion.