右美托咪定对神经外科手术患者全麻苏醒期躁动的影响

Effect of dexmedetomidine on restlessness in department of neurosurgery operation patients during anesthesia recovery period

目的:观察盐酸右美托咪定(Dex)对神经外科手术患者全麻苏醒期躁动的影响。方法:选择2015年6月—2016年10月择期行神经外科手术患者60例。按随机数字表法分为D_5组(右美托咪定0.5μg·kg^(-1)·h^(-1))、D_2组(右美托咪定0.2μg·kg^(-1)·h^(-1)组)和N组(空白对照组),每组各20例。D_5组、D_2组于麻醉诱导后10 min分别泵入右美托咪定0.5μg·kg^(-1)·h^(-1)、0.2μg·kg^(-1)·h^(-1)至手术结束前30 min。N组未予右美托咪定。术中维持BIS值40~50之内,分别观察记录三组患者麻醉手术时长及术中麻醉药物的用量;全麻诱导前(T_0)、苏醒期患者拔管时(T_1)及拔管后10 min(T_2)的心率(HR)、脉搏血氧饱和度(SpO_2)、血压(BP)、平均动脉压(MAP)等基本生命体征及拔管后10 min镇静-躁动评分(RASS评分)。结果:麻醉手术期使BIS维持在40~50范围之内麻醉药物用量:D_5组明显低于N组(P<0.05),D_2组低于D_5组(P>0.05);拔管时及拔管后生命体征:D_5组较平稳,其HR、MAP降低,并且均在正常范围内;苏醒期RASS评分:D_5、D_2组明显低于N组(P<0.05),D_5组低于D_2组(P<0.05)。结论:右美托咪定可改善神经外科手术患者全麻苏醒期拔管时血流动力学稳定性及躁动情况,其镇静、镇痛作用显著,且0.5μg·kg^(-1)·h^(-1)剂量下血流动力学更平稳,产生的镇静、镇痛效果较满意,可减少术中麻醉药物的用量。

Objective： To observe the effect of dexmedetomidine（ Dex） on the effect of agitation in patients with general anesthesia of the Department of Neurosurgery surgery. Methods： All 60 cases of surgical patients in our hospital from June 2015 to October 2016 were selected. Were randomly divided into D5 group（ dexmedetomidine 0. 5 μg·kg^-1·h^-1,n = 20）,D2 group（ dexmedetomidine 0. 2 μg·kg^-1·h^-1,n = 20） and N group（ control group,n = 20）. D5 group,D2 group： 10 min after induction of anesthesia with dexmedetomidine infusion were 0. 5μg·kg^-1·h^-1、0. 2 μg·kg^-1·h^-1 to 30 min before the end of surgery. Group N： no dexmedetomidine. For maintaining the BIS value from 40 to 50 within the range,were recorded in three groups of patients with anesthesia duration and intraoperative anesthetic dosage; before induction of anesthesia（ T0）,pull the analepsia period tube（ T1） and 10 min after extubation（ T2） heart rate（ HR）,Pulse oximetry（ SpO2）,blood pressure（ BP）,mean arterial blood pressure（ MAP） and other basic life signs and 10 min after extubation sedation agitation score（ RASS score）. Results： During the operation. BIS was maintained at 40 - 50 within the scope of use of narcotic drugs： D5 group was significantly lower than N group（ P〈0. 05）,D2 group was lower than that of D5 group（ P〉0. 05）,D2 group was lower than that of D5 group（ P〉0. 05）; extubation and after extubation of vital signs： compared to D5 group the HR stable,and MAP decreased,and were in the normal range; the recovery period of RASS score： D5,D2 group was significantly lower than N group（ P〈0. 05）,D5 group was lower than that of D2 group（ P〈0. 05）. Conclusion Dexmedetomidine can improve the Department of Neurosurgery surgery with general anesthesia during extubation hemodynamic stability and restlessness,its sedative and analgesic effect significantly,and 0. 5 μg·kg-（-1）·h-（-1）dose more stable hemodynamics,sedative and analgesic effect produced satisfactory,can reduce the dosage of narcotic drugs in operation.