右美托咪啶在急腹症手术中的应用

Application of Dexmedetomidine in Operations for Acute Abdominal Diseases

目的:探讨右美托咪啶在急腹症手术中应用效果。方法:行急腹症手术患者91例,根据麻醉用药的不同分为两组:对照组采用丙泊酚和瑞芬太尼注射液进行麻醉,右美托咪啶组在对照组基础上,麻醉诱导前15 min泵注右美托咪啶注射液0.5μg/kg,继之持续泵注右美托咪啶注射液0.2μg·kg-1·h-1至手术结束前40 min停药;观察两组用药前、插管时、拔管时和拔管后30 min时的血压与心率变化、丙泊酚注射液和瑞芬太尼注射液的使用量以及不良反应发生率,术后30 min进行视觉模拟评分法(VAS法)评分。结果:右旋美托咪啶组丙泊酚注射液(0.08±0.01)mg·kg^(-1)·min^(-1)、瑞太尼注射液(0.07±0.02)μg·kg^(-1)·min^(-1)使用量较对照组丙泊酚注射液(0.10±0.02)mg·kg^(-1)·min^(-1)、瑞太尼注射液(0.13±0.02)μg·kg^(-1)·min^(-1)使用量明显减少(P<0.01);右旋美托咪啶组拔管时呛咳、术后恶心呕吐、寒颤发生率(4.26%)和术后30 min VAS得分(1.45±0.03)较对照组拔管时呛咳、术后恶心呕吐、寒颤发生率(40.91%)和术后30 min VAS得分(3.80±0.30)明显减少(P<0.01);右旋美托咪啶组用药前后各时间点SBP、DBP和HR较对照组明显降低(P<0.05)。结论:右美托咪啶复合丙泊酚、瑞芬太尼输注用于急腹症手术,可减少术中应激反应,能维持循环稳定,减少麻醉药物的用量,降低不良反应发生率。

ObjectiveTo investigate the clinical advantages of dexmedetomidine in acute abdominal oper-ations.MethodsNinety-one cases of acute abdominal diseases were operated with different anesthetic drugsas being divided into 2 groups,the dexmedetomidine group（47 cases）and propofol and remifentanil（the controlgroup,44 cases）.Patients in the control group were infused with propofol injection and remifentanil injection.Pa-tients in dexmedetomidine group were infused with dexmedetomidine injection（0.5 μg/kg）15 minutes before an-esthesia induction and then given the maintenance dose of dexmedetomidine injection 0.2 μg·kg^（-1）·h^（-1）until 40 minutes before the end of operation.Systolic blood pressure（SBP）,diastolic blood pressure（DBP）and heartrate（HR）were recorded before administration,at intubation,at extubation,and 30 min after extubation.Dosagesof profol,fentanyl and dexmedetomidine injection,and incidences of perioperative adverse reactions were ob-served in both groups.VAS score was compared between the two groups 30 min after operation.ResultsTheusage amount of propofol（0.08±0.01）mg·kg^-1·min^-1nd fentanyl（0.07±0.02）μg·kg^-1·min^-1njection in dexme-detomidine group were lower than those of the control group（0.10±0.02）mg·kg^（-1）·min-1and（0.13±0.02）μg·kg^-1·min^-1P〈0.01）.The incidences of extubation cough,nausea,vomiting and shivering（4.26%）and postoper-ative VAS score（1.45±0.03）in dexmedetomidine group were lower than those of the control group（40.91%）and（3.80±0.30）（P〈0.01）.SBP,DBP and HR in dexmedetomidine group were lower than those of the control group（P〈0.05）.ConclusionDexmedetomidine injection can relieve intraoperative stress response,maintain circu-lation stability,reduce anesthetic usage,and decrease the incidence of perioperative adverse reactions in acuteabdominal diseases.