右美托咪定复合七氟醚对上腹部手术患者麻醉恢复的影响

Effect of dexmedetomidine combined with sevoflurane on anesthesia recovery in patients undergoing upper abdominal surgery

目的观察不同浓度右美托咪定复合七氟醚对上腹部手术患者麻醉恢复的影响。方法全麻下行上腹部手术患者135例,美国麻醉医师协会分级Ⅰ~Ⅱ级,随机均分为不同剂量右美托咪定组(D1组、D2组)和对照组(C组),每组各45例。D1组和D2组诱导后15 min内均静脉泵注右美托咪定1.0μg/kg,随后分别以0.3μg·kg^(-1)·h^(-1)、0.6μg·kg^(-1)·h^(-1)速率输注至手术结束前30 min。C组输注等容量0.9%氯化钠注射液,记录三组患者自主呼吸恢复时间、苏醒时间、拔除气管导管时间及术后不良反应并分析;并分别于麻醉前、术后2 h、4 h、12 h和24 h抽取静脉血,检测血清内皮素-1(ET-1)水平。结果 D1组和D2组镇痛有效率均明显高于C组,差异均有统计学意义(χ~2分别=5.61、3.79,P均<0.05);D1组和D2组患者呛咳、恶心呕吐、躁动和寒战发生率均明显低于C组,差异均有统计学意义(χ~2分别=2.98、3.13、3.26、5.25、3.06、4.13、3.56、6.81,P均<0.05);D1组和D2组术后2 h、4 h、12 h和24 h的ET-1水平均明显低于C组,差异均有统计学意义(t分别=2.17、3.21、2.62、4.15、2.49、3.57、2.78、4.66,P均<0.05);D2组术后4 h血浆ET-1水平明显低于D1组,差异有统计学意义(t=2.33,P<0.05)。结论七氟醚复合0.6μg·kg^(-1)·h^(-1)右美托咪定对麻醉恢复更为有效和安全。

Objective To observe the effect of dexmedetomidine combined with sevoflurane on anesthesia recovery in patients undergoing upper abdominal surgery. Methods A total of 135 patients underwent upper abdominal operation under general anesthesia whose ASA degree was I to II were randomly divided into group D1, group D2 and control group with 45 cases in each. Group D1 and group D2 were all received dexmedetomidine at an initial dose of 1.0 μg /kg over 15 minutes, and then group D1 and group D2 were continuously infused dexmedetomidine at speed of 0.3 μg·kg^（-1）·h^（-1）and0.6 μg·kg^（-1）·h^（-1）respectively until 30 min before the end of surgery. Group C was received saline solution with the same volume. The time for recovery of spontaneous breathing, awaking time, extubation time and adverse reaction were recorded.The serum ET-1 level was detected by ELISA at before anesthesia, 2 hours, 4 hours, 12 hours and 24 hours after surgery.Results Compared with group C, the analgesia efficient rate of group D1 and group D2 were significantly higher（χ~2=5.61, 3.79, P 0.05）. The incidence of cough, nausea and vomiting, restlessness and shivering were significantly lower than group C（χ~2=2.98, 3.13, 3.26, 5.25, 3.06, 4.13, 3.56, 6.81, P〈0. 05）. The serum ET-1 level of group D1 and group D2 at 2 h, 4 h, 12 h and 24 h after operation were significantly lower than those of groups C（t=2.17, 3.21, 2.62,4.15, 2.49, 3.57, 2.78, 4.66, P〈0.05）.The serum ET-1 level of group D2 at 4 hours after operation were significantly lower than that of group D1（t=2.33, P〈0.05）. Conclusion Sevoflurane combined with 0.6 μg·kg^（-1）·h^（-1） dexmedetomidine is more effective and safer for anesthesia recovery.