右美托咪定对Wilson病继发脾功能亢进患者全身麻醉下脾切除术后躁动的影响

Effects of Dexmedetomidine on Agitation of Wilson's Disease Patients with Secondary Hypersplenism after General Anesthesia of Splonectomy

目的:观察右美托咪定对Wilson病继发脾功能亢进患者全身麻醉下脾切除术后躁动的影响。方法:选取某院2016年1-12月的全身麻醉下行脾切除术Wilson病继发脾功能亢进患者60例,按随机数字表法分为对照组和观察组,各30例。观察组患者麻醉诱导前15 min静脉恒速泵注右美托咪定0.4μg/kg,之后为0.4μg/(kg·h)维持至脾切除后;对照组患者给予等量的生理盐水,其余麻醉方案两组相同。观察两组患者开始泵注前(T_0)、插管前(T_1)、插管后1 min(T_2)、拔管前(T_3)及拔管后3 min(T_4)的平均动脉压(MAP)、心率(HR)和血氧饱和度(SpO_2),记录两组患者T_3和T_4时间点Riker镇静-躁动评分(SAS),比较两组患者麻醉后监测治疗室(PACU)停留时间及心动过缓发生情况。结果:T_0时,两组患者MAP、HR、SpO_2水平比较,差异无统计学意义(P>0.05);T1、T_2、T_3、T_4时,两组患者MAP、HR水平均显著降低,且观察组显著低于对照组,差异均有统计学意义(P<0.05);但SpO_2所有时间点均为100%,组间比较,差异无统计学意义(P>0.05)。观察组患者T_3、T_4时Riker SAS评分均显著低于对照组,差异均有统计学意义(P<0.05)。观察组患者心动过缓发生率为26.67%,显著高于对照组的3.33%,差异有统计学意义(P<0.05),但静脉注射阿托品后均得以纠正。观察组PACU停留时间显著短于对照组,差异有统计学意义(P<0.05)。结论:右美托咪定能稳定Wilson病继发脾功能亢进患者术后血流动力学,降低躁动情况,并缩短PACU转出时间。

OBJECTIVE： To observe the effects of dexmedetomidine （Dex） on postoperative agitation of Wilson＇ s disease patients with secondary hypersplenism after genernl anesthesia of splenectomy. METHODS： A total of 60 Wilson＇ s disease patients with secondary hypersplenism underwent general anesthesia of splenectomy duning Jan.-Dec. 2016 were divided into control group and observation group according to random number table, with 30 cases in each group. Observation group was given intravenous pump of Dex 0.4 -tg/kg at constant speed 15 min before anesthesia induction, and then maintained at 0.4 pg/（kg.h）till splenectomy completed. Control group was given constant volume of normal saline. Other anesthesia plans were same in 2 groups. Mean arterial pressure （MAP）, heart rate （HR） and pulse oxygen saturation （SpO2） of 2 groups were observed before pumping （To）, before in- tubation （T-）, 1 rain after intubation （T2）, before extubation （T3）, 3 rain after extubation （T4）. Riker sedation-agitation score （SAS） were recorded in 2 groups at T3 and T4. The duration of stay in postanesthesia intensive care unit （PACU） and the occur- rence of bradycardia were compared between 2 groups. RESULTS： At To, there was no statistical significance in MAP, HR or SpO2 levels between 2 groups （P〉0.05）. At T-, T2, T3 and T4, MAP and HR levels of 2 groups were decreased significantly, and the observation group was significantly lower than the control group, with statistical significance （P〈0.05）. SpO2 were 100% at each time point, there was no statistical significance between 2 groups （P〉0.05）. Riker SAS scores of observation group was sig- nificantly lower than that of control group, with statistical significance （P〈0.05）. The incidence of bradycardia in observation group was 26.67 %, which was significantly higher than 3.33 % of control group, with statistical significance （P〈0.05）. But this symptom was corrected after intravenous injection of atropine. The duration of stay in PACU in observation group was significant- ly shorter than control group, with statistical significance （P〈0.05）. CONCLUSIONS： Dex can keep postoperative hemodynam- ics stable in Wilson＇s disease patients with secondary hypersplenism, reduce agitation and shorten the time of the patients transferring from PACU.