右美托咪定对腹部手术患者全身麻醉苏醒期呼吸、血流动力学、BIS值的影响

The Effect of Dexmedetomidine on Hemodynamics,Respiratory,BIS Value after General Anesthesia of Abdominal Operation

目的探讨腹部术中全麻处理时,右美托咪定对患者苏醒期血流动力学、呼吸、BIS值的影响。方法选取宜宾市矿山急救医院2014-01/2015-06接诊的择期全麻开腹手术患者57例,按照随机数字排列法将其分为两组,其中对照组患者27例,给予10ml生理盐水,观察组患者27例,给予其0.6μg/kg右美托咪定,术中以氧气、七氟醚、芬太尼、阿曲库铵行维持麻醉,手术结束前30min,经静脉泵入试验药物。观测两组患者手术指标、各时间点血流动力学、呼吸、BIS值变化,测定镇痛效果,记录镇痛时间。结果两组患者手术时间、麻醉时间、尿量、丙泊酚与芬太尼使用剂量、术中输液量与出血量对比差异无统计学意义(P>0.05);两组入室时、用药时、用药后5min SBP、DBP对比差异无统计学意义(P>0.05);观察组用药后10min SBP高于对照组,拔管时、拔管后3min、5min、10min SBP较之对照组更低(P<0.05);观察组拔管时、拔管后3min、5min、10min DBP较之对照组更低(P<0.05),两组入室时、用药时、用药后5min HR对比差异无统计学意义(P>0.05);观察组用药后10min、拔管时、拔管后3min、5min、10min HR较之对照组更低(P<0.05);两组入室时RPP对比差异(P>0.05);观察组拔管时、拔管后1min、3min、5min RPP较之对照组更低(P<0.05);两组入室时、用药时、用药后5min、10min、拔管时、拔管后3min、5min、10min BIS值测定结果对比无差异(P>0.05);观察组自主呼吸恢复时间更短,术后2h VAS评分更低,术后镇痛时间更长(P<0.05);观察组手术费与对照差异无统计学意义(P>0.05),但住院时间更短(P<0.05);对照组不良反应率为14.81%,观察组不良反应率为7.41%(P<0.05)。结论腹部手术全麻处理中,运用右美托咪定可有效减轻患者的拔管应激反应,尤其是在稳定血流动力学上效果显著,且不会对呼吸造成过大影响,同时还具有较好的镇痛效果。

Objective To investigate the dexmedetomidine treatment after general anesthesia in abdominal surgery,evaluate the hemodynamics in recovery period,respiration and BIS values. Methods There were 57 abdominal surgery cases selected in Yibin Kuangshan Emergency Hospital from January 2014 to 2015 June. According to random number table method,the patients were divided into two groups： the control group of 27 patients took normal saline（ 10 ml）; observation group of 27 patients took 0. 6 μg / kg dexmedetomidine,and oxygen,sevoflurane and fentanyl,atracurium,was maintained in intraoperative anesthesia. Before 30 minutes of operation end,dexmedetomidine was injected though the infusion pump. The data of operation observation index,the hemodynamics,respiration,the change of BIS,effect of analgesic and onset time were recorded.Results There were several indexes were no significant difference（ P〉0. 05） including surgery time,anesthesia time,urine,propofol and fentanyl dose,and intraoperative fluid volume and blood loss.Indexes of observation group was higher than control group： at the intervention of 10 min and extubation of 3 min,5min（ systolic blood pressure,P〈0. 05）; extubation of 3min,5min,10min（ diastolic blood pressure lower,P〈0. 05）; intervention of 10 min,extubation of 3min,5min,3min（ heart rate,P〈0. 05）; extubation of 1min,3min,5min（ Rate- pressure- Product lower,P〈0. 05）. In the observation group,the recovery time and VAS 2h score were shorter,and the postoperative analgesia time was longer（ P〈0. 05）. In the observation group,the length of hospital stay was shorter（ P〈0. 05））,the adverse reaction rate was different（ observation 7. 41% vs. control 14. 81%,P〈0. 05）. Conclusion Dexmedetomidine treatment could effectively reduce the extubation reaction,especially keep hemodynamic stable obviously with ideal analgesic effect,without respiratory depression after general anesthesia in abdominal surgery.