右美托咪啶对老年创伤性颅脑损伤合并心血管病患者手术全麻恢复期质量的影响

Effect of dexmedetomidine on quality of emergence from general anesthesia in elderly traumatic brain injury patients with cardiovascular disease

目的观察右美托咪啶对老年创伤性颅脑损伤（TBI）合并心血管病患者手术全麻恢复期质量的影响。方法 88例择期行开颅手术ASA分级Ⅰ~Ⅱ级的老年TBI合并心血管病患者,按随机数字表法分为右美托咪啶组（n=44）和对照组（n=44）。右美托咪啶组麻醉诱导后15 min内静脉泵注右美托咪定1.0μg/kg,随后按速率0.6μg·kg-1·h-1输注至手术结束前30 min,对照组输注等容量0.9%氯化钠注射液。两组均采用全身麻醉,比较两组患者的麻醉恢复情况、镇痛有效情况、全麻恢复期不良反应、拔管后的视觉模拟评分（VAS）和Ramsay镇静评分、血浆肾上腺素（E）、去甲肾上腺素（NE）和内皮素-1（ET-1）。结果右美托咪啶组镇痛有效率明显高于对照组,差异有统计学意义（χ2=5.61,P〈0.05）。右美托咪啶组拔管后5 min、30 min、60 min、120 min VAS评分均低于对照组（t分别=3.21、2.87、4.14、3.63,P均〈0.05）,拔管后5 min、30 min、60 min Ramsay镇静评分均高于对照组（t分别=1.49、4.53、3.81,P均〈0.05）。右美托咪啶组躁动、寒战、呛咳、恶心呕吐发生率均明显低于对照组（χ2分别=3.21、4.53、1.79、2.43,P均〈0.05）。右美托咪啶组术后2 h、4 h、12 h和24 h的E、NE和ET-1水平均明显低于对照组（t分别=3.21、3.02、3.61、4.15、3.89、3.15、4.52、3.37、3.58、4.62、4.74、3.71,P均〈0.05）。结论全麻时持续静脉输注右美托咪啶可有效改善老年TBI合并心血管病患者全麻恢复期的质量。

Objective To evaluate the effect of dexmedetomidine on the quality of emergence from general anesthesia in the elderly traumatic brain injury patients with cardiovascular disease. Methods A total of 88 ASA Ⅰ~Ⅱpatients were randomly divided the dexmedetomidine group and the control group with 44 patients in each. The dexmedetomidine group was given dexmedetomidine at an initial dose of 1.0 μg /kg over 15 minutes,followed by a continuous infusion of 0.6μg/kg per hours until 30 min before the end of surgery, the control group was given normal instead. General anesthesia were used in the two groups. The recovery of anesthesia, analgesic effective situation,adverse reaction,visual analogue scale（VAS） and Ramsay sedation score after extubation, epinephrine（E）,norepinephrine（NE） and endothelin 1（ET-1）between two groups were compared. Results The rate of effective analgesia in the dexmedetomidine group was significantly higher than the control group（χ2=5.61,P0.05）. The scores of VAS in the dexmedetomidine group were lower than the control group at 5 min,30 min,60 min, 120 min after extubation（t=3.21,2.87, 4.14, 3.63, P0.05）. The scores of Ramsay sedation in the dexmedetomidine group were higher than the control group at 5 min, 30 min, 60 min after extubation（t=1.49,4.53,3.81,P0.05）. The incidence of restlessness,chills,cough,nausea and vomiting in the dexmedetomidine group were significantly lower than the control group（χ2=3.21,4.53,1.79,2.43,P0.05）. The levels of serum E,NE and ET-1 in the dexmedetomidine group were significantly lower than the control group at 2 h, 4 h, 12 h and24 h after operation（t= 3.21, 3.02, 3.61, 4.15,3.89,3.15,4.52,3.37,3.58,4.62,4.74,3.71,P0.05）.Conclusion Intravenous continuous infusion of dexmedetomidine can effectively improve the quality of emergence from general anesthesia in the elderly traumatic brain injury patients with cardiovascular disease.