静脉注射不同剂量右美托咪定对全喉切除术后患者呛咳和躁动的影响

Effect of injecting different doses of dexmedetomidine intravenously on preventing cough reflex and agitation in patients with total laryngectomy

目的比较不同剂量右美托咪定对全喉切除术后患者呛咳和躁动的影响。方法选择90例择期行全喉切除术的患者,ASA分级Ⅰ~Ⅱ级,根据随机数字表分为3组,每组30例。手术结束前30 min给予不同的药物：对照组（C组）给予生理盐水50 mL,右美0.5μg/kg组（D0.5组）给予右美托咪定0.5μg/kg,右美1μg/kg组（D1组）给予右美托咪定1μg/kg,后两组药物均加生理盐水至50 mL,并在10 min内注射完毕。记录患者注入前、注入后、苏醒时（即患者能听从口头指令睁眼时）的心率、收缩压、舒张压以及术后呛咳、Ramsay镇静评分以及切口出血情况。结果给药后,3组间心率差异均有统计学意义,D1组心率降低最明显,但各组间血压相似;苏醒期,3组组间心率和收缩压差异均有统计学意义,C组较D1和D0.5组舒张压有显著升高;D1组的苏醒时间显著长于其余两组。与C组相比,D1和D0.5组的术后呛咳、Ramsay镇静评分、切口出血均有明显改善。结论静注右美托咪定能够显著改善全喉切除术后的呛咳反应和苏醒期躁动,右美托咪定0.5μg/kg对于心率和苏醒时间的影响较1μg/kg更小。

Objective To compare the effect of different doses of dexmedetomidine on incidence of cough reflex and agitation after total laryngectomy. Methods Ninety patients scheduled for total laryngectomy（ASAⅠ-Ⅱ）were enrolled and assigned into three groups according to the ramdomized digits table.Each group contained 30 patients.Thirty minutes before the end of the surgery,patients in the control group（group C）received 50 mL saline intravenously.Group D0.5and Group D1 received dexmedetomidine 0.5μg/kg and 1.0μg/kg respectively.All the different doses of dexmedetomidine were diluted into 50 mL with saline and administered over a period of 10 minutes.The heart rate（HR）,systolic blood pressure（SBP）and diastolic blood pressure（DBP）were recorded before administration,after administration and after recovery（the moment patients could follow verbal command and open their eyes）.Ramsay sedative score,severity of coughing and incidence of wound bleeding were also evaluated postoperatively. Results There was statistic between-group difference of HR among all the 3 groups after administration.HR in group D1 declined most prominently,but the SBP and DBP were similar among the three groups.After recovery,there was statistic between-group difference of HR and SBP among all the 3 groups,while DBP in group C was significantly higher than the other two groups.The recovery time was significantly prolonged in group D1 than the other two groups.Compared with group C,the severity of coughing,Ramsay sedation score and incidence of wound bleeding were markedly improved in group D1 and D0.5. Conclusions Injecting dexmedetomidine intravenously could prominently improve coughing incidence and agitation in recovery.Compared with 1μg/kg dose,0.5μg/kg of dexmedetomidine has weaker effect on HR and recovery time.