右美托咪定对七氟醚吸入全身麻醉术后恢复质量的影响

Effects of dexmedetomidine on post-operative recovery quality in patients undergoing sevoflurane inhalation general anesthesia

目的 通过分析比较手术前后精神功能紊乱的发生情况,探讨右美托咪定对七氟醚吸入全身麻醉术后恢复质量的影响。方法 择期腹腔镜胃肠手术患者80例,ASAⅠ～Ⅱ级,年龄30～65岁,随机分为两组,右美组和对照组,每组40例。右美组在全身麻醉插管后给予右美托咪定负荷剂量0.4μg·kg-1,10 min输注完毕,继以0.4μg·kg-1·h-1持续泵注,手术结束前30 min停止输注;对照组以相同方法给予0.9%氯化钠注射液。两组麻醉诱导方法相同,术中七氟醚吸入维持。记录两组患者术中的心率和平均动脉压。分别于术前、拔管后30 m in和术后4 d用术后恢复质量量表（PQRS量表）对患者进行评估。结果 两组患者术前的PQRS评分差异无统计学意义（P〉0.05）。右美组的苏醒期躁动发生率明显低于对照组（P〈0.05）。拔管后30 min右美组PQRS量表生理因素评分明显高于对照组（P〈0.05）。术后4 d右美组PQRS量表认知因素评分明显高于对照组（P〈0.05）。结论 右美托咪定可以降低全身麻醉苏醒期躁动的发生率并改善患者的术后认知功能,显著提高七氟醚吸入全身麻醉术后恢复质量。

Objective To evaluate the effect of dexmedetomidine on postoperative recovery quality in patients undergoing sevoflurane inhalation general anesthesia. Methods Eighty ASA Ⅰ or Ⅱ patients aged 30 to 65 undergoing selective laparoscopic gastrointestinal surgery were randomly divided into 2 groups （n = 40 each） ： patients in dexmedetomidine group were given dexmedetomidine after intubation at loading dose of 0.4 μg/kg for 10 min, then at maintaining dose of 0.4 μg/kg/h until 30 min before the end of operation; patients in control group were given 0.9% normal saline at the same volume. Anesthesia was maintained by inhalation of seven sevoflurane in two groups. Heart rate and mean arterial pressure during the surgery were recorded. Post-operative Quality Recovery Scale（PQRS） was evaluated before operation, 30 min after extubation and at d4 after operation. Results The scores of PQRS before surgery were not different between two groups （P 〉 0. 05 ）. The score of physiology of PQRS in dexmedetomidine group was significantly higher 30 min after extubation, compared with that in control group （P 〈 0. 05 ）. The cognitive score of PQRS in dexmedetomidine group was significantly higher 4 d after surgery compared with that in control group （P 〈 0. 05 ）. Conclusion Dexmedetomidine can significantly improve postoperative recovery quality and effectively reduce the emergence of agitation in patients undergoing general anesthesia.