右美托咪定经鼻滴注对脊柱手术患者围术期血流动力学变化及镇静作用的临床研究

Effects of Dexmedetomidine(DEX) Administered Nasal Drops on Hemodynamic Changes and Sedation in Patients with Spinal Surgery Perioperatively

目的:观察右美托咪定经鼻滴注对脊柱手术患者围术期的镇静作用及对血流动力学变化的影响。方法:将90名ASAⅠ~Ⅲ级、18~65岁、拟在全身麻醉下行脊柱手术、且术后须拔除气管导管的患者,随机分为三组:对照组(C组)、右美托咪定1μg/kg组(D1组)和右美托咪定1.5μg/kg组(D2组),n=30。分别记录给药前(T0)、诱导前(T1)、插管前1 min(T2)、插管后1 min(T3)、手术开始即刻(T4)、术毕停全麻药时(T5)、拔管前1 min(T6)、拔管后3 min(T7)和入PACU(T8)时患者的心率(HR)、平均动脉压(MAP)、氧饱和度(SPO_2),术毕停全麻药至拔除气管导管的时间、患者在术后恢复室停留时间、Ramsay镇静评分。结果:T0时3组患者HR、MAP、SPO_2、Ramsay镇静评分无统计学差异(P≥0.05);与C组相比,D1组和D2组各时间点HR、MAP明显降低,Ramsay镇静评分提高(P≤0.05),SPO_2无明显变化(P≥0.05);与D1组相比,D2组各时间点HR、MAP明显降低、Ramsay镇静评分提高(P≤0.05),SPO_2无明显变化(P≥0.05);D1组各时间点HR、MAP、SPO_2、Ramsay镇静评分无明显差异(P≥0.05);D2组HR、MAP、SPO_2、Ramsay镇静评分明显无差异(P≥0.05)。C组T3、T4、T5、T6、T7、T8各时间点HR、MAP均较T1、T2升高,Ramsay镇静评分均明显提高(P≤0.05),SPO_2无明显变化(P≥0.05)。结论:麻醉诱导前40 min右美托咪定经鼻滴注可有效抑制插管和拔管期反应、使血流动力学变化更加稳定,并显著降低降低患者术后躁动的发生率。

Objective： To observe the dexmedetomidine by nasal drip on perioperative spinal surgery patients sedation and the effect of hemodynamic changes. Methods： 90 ASA grade I -III, years 18 to 65, and in general anesthesia spinal surgery, and postoperative patients have to extube the endotracheal, were randomly divided into three groups： control group （group C）, the dexmedetomidine 0.1 p.g/kggroup （D1） and dexmedetomidine 1.5 μg/kggroup （D2）, （n=30）. Record into the OR （TO）, before the induction （T1）, 1 min before intubation （T2）, 1 min after intubation （T3）, start surgy （T4）, began to stop general anesthetics （T5）, 1 min before extubation （T6）, 3 min after extubation （T7）, and into the PACU （T8）. The patient＇s heart rate （HR）, mean arterial pressure （MAP）, oxygen saturation （SPO2）, finish operation fi＇om the general anesthetics toextube the endotracheal tube, stay time, patients in the postoperative recovery room Ramsay sedation scores. Results： Three groups of patients when TO HR, MAP, SPOt, Ramsay sedation scores had no statistical dif- ference （P≥0.05）; Compared with group C, D1 and D2 group significantly lower each time point of HR, MAP, Ramsay sedation scores increase （P≤0.05）, SPO2 no significant change （P〉 0.05）; Each time point compared with group D1, D2 group HR, MAP, significantly decreased, Ramsay sedation scores increase （P≤ 0.05）, SPO2 no significant change （P= 0.05）; D1 group HR, MAP, SPO2 at each time point, Ramsay sedation scores have no obvious difference （P≥ 0.05）; D2 group HR, MAP, SPO2, Ramsay sedation scores significantly difference （P≥0.05）. Group C T3, T4, T5, T6, T7 has each time point, T8 HR, MAP, up from T1, T2, Ramsay sedation scores were significantly improved （P〈 0.05）, SPO2 no significant change （P≥ 0.05）. Conclusions： 40 min before anesthesia induction dexmedetomidine by nasal drip can effectively inhibit intubation and extubation reaction, make the hemodynamic changes is more stable, and significantly reduce the incidence of patients with postoperative agitation.