不同剂量右美托咪定持续静脉注射对颈部手术患者麻黄碱升压反应及全麻恢复期的影响对照研究

Effects of dexmedetomidine continuous intravenous infusion on the hemodynamic response of ephedrine and the recovery process of patients undergoing neck surgery under general anesthesia

目的对比研究不同剂量右美托咪定持续静脉注射对颈部手术患者麻黄碱升压反应及全麻恢复期的影响。方法选取2015年1月-2015年12月期间在永康市第一人民医院住院择期拟行全麻下手术治疗的100例颈部疾病患者,随机分为低剂量组与高剂量组,每组各50例,分别在手术开始前10 min静脉滴注右美托咪定0.4、0.8μg/kg,10 min后均为0.4μg/（kg·h）,2组均直至术毕停药;2组均在气管插管成功后5 min给予麻黄碱0.1 mg/kg,观察入室时（T0）、麻醉诱导后（T1）、气管插管即刻（T2）、给予麻黄碱时（T3）的心率（HR）、收缩压（SBP）、舒张压（DBP）,给予麻黄碱后10 min后的HR、血压（BP）最大值所需时间（TBP、THR）,HR、SBP、DBP升幅、恢复期相关指标。结果 2组T0时HR、SBP、DBP水平比较差异无统计学意义,2组T1、T2、T3时HR、SBP、DBP均低于T0时（P〈0.05）,高剂量组T1、T2、T3时HR、SBP、DBP均低于低剂量组（P〈0.05）;2组患者给与麻黄碱后10 min后的TBP、THR比较差异无统计学意义,HR、SBP、DBP升幅高剂量明显大于低剂量组（P〈0.05）;高剂量组拔管后呛咳评分、镇静-躁动评分均低于低剂量组（P〈0.05）,自主呼吸恢复时间、拔管时间、呼之睁眼时间、定向力恢复时间2组比较差异均无统计学意义。结论 0.8μg/kg右美托咪定持续静脉注射对颈部手术患者麻黄碱升压效应强于0.4μg/kg剂量,0.8μg/kg相对于0.4μg/kg剂量更利于减少恢复期的呛咳及躁动,不同剂量对苏醒无明显影响。

Objective To investigate the effects of dexmedetomidine continuous intravenous infusion on the hemodynamic response of ephedrine and the recovery process of patients undergoing neck surgery under general anesthesia. Methods Select elective fitting line surgery under general anesthesia of 100 patients with cervical disease from January 2015 to December 2015 in the First People＇s Hospital of Yongkang,randomly divided into low dose group and high dose group,50 cases in each group,before induction of anesthesia,patients received continuous intravenous pumping of dexmedetomidine 0. 4 μg/kg in low dose group or 0. 8 μg/kg in high dose group,after ten mins 0. 4 μg/kg prior to anesthesia induction,until the end of operation withdrawal; 5 min after laryngeal mask insertion,ephedrine 0. 1 mg/kg were intravenous administered in two groups. Observe the following indicators： the after entering the operation room（T0）,anesthesia before induction（T1）,after induction（T2）,administration of ephedrine（T3）,the maximum value time（TBP,THR） of heart rate and blood pressure in 10 minutes. Increased of HR,SBP,DBP,recovery related indicators. Results HR,SBP and DBP levels compared no significant difference of T0 with two groups,T1,T2 and T3,HR,SBP,DBP were lower than T0 with two groups（P〈0. 05）,high dose group were lower than low dose group of HR,SBP,DBP（P〈0. 05）; TBPand THRno significant difference of two groups,high dose group were higher than low dose group of Increased of HR,SBP,DBP（P〈0. 05）; high dose group were lower than low dose group of after extubation cough score and sedation agitation score（P〈0. 05）. Spontaneous breathing recovery time and extubation time,called the open time,orientation recovery time,the difference between the two groups was not statistically significant. Conclusion 0. 8 μg/kg dexmedetomidine continuous intravenous injection of ephedrine in patients with neck pressor effect stronger than the 0. 4 μg/kg,0. 8 μg/kg compared with 0. 4 μg/kg can reduce the recovery period of cough and restlessness,different doses had no effect on recovery.