右美托咪定气管内给药对妇科腹腔镜手术患者全麻苏醒期的影响

Effects of Dexmedetomidine Intratracheal Instillation on Quality of Emergence from General Anesthesia in Patients Undergoing Gynecologic Laparoscopic Operation

【目的】评价右美托咪定气管内给药对妇科腹腔镜手术患者全麻苏醒期的影响。【方法】选择择期全麻妇科腹腔镜手术患者90例,预计手术时间1~2 h,术后需拔除气管导管,ASAⅠ~Ⅱ级,年龄18~64岁,体质量40~80kg,采用随机数字表法,将其分为3组(n=30):对照组(C组)、右美托咪定气管内给药组(D1组)、右美托咪定静脉给药组(D2组)。手术开始时D1组通过一次性使用麻醉增强Ⅲ型气管导管的注药孔注入右美托咪定2μg/kg,D2组患者单次静脉泵注右美托咪定0.5μg/kg,10 min内注药完毕,C组静脉泵注生理盐水。术毕拔除气管导管送入麻醉恢复室。记录患者给右美托咪定即刻(T_0)、给药后5、10、15、30 min(记为T_1~T_4)、拔管即刻(T5)、拔管后5、10、15、30min(记为T_6~T_9)时MAP、HR。记录患者自主呼吸恢复时间等、拔管期间呛咳评分和镇静-躁动(SAS)评分、拔管后30 min时视觉模拟评分(VAS)和Ramsay镇静评分。【结果】(1)与同组T0时比较,C组T_5~T_7时点MAP、HR显著升高,D1组和D2组T5~T6时点MAP显著升高,T_5~T_7时点HR显著升高(P<0.05);与C组同时间点比较,T_5~T_7时点D1组和D2组MAP、HR显著降低(P<0.05);(2)D1、D2组呛咳评分、SAS评分和VAS评分显著低于C组(P<0.05);(3)D1、D2组躁动、高血压和心动过速发生率显著低于C组(P<0.05)。【结论】静脉注射或气管内给予右美托咪定均能使妇科腹腔镜手术患者全麻恢复期的血流动力学更稳定,减少呛咳和躁动的发生,提高了全麻苏醒期的质量。

【Objective】To evaluate the effects of dexmedetomidine intratracheal instillation on quality of emergence from general anesthesia in patients undergoing gynecologic laparoscopic operation. 【Methods】Ninety patients of ASA I orⅡ,aged 18~64 years old,weighed 40~80 kg,scheduled for elective gynecological 1 aparoscopic surgery under general anesthesia,expected surgery time 1-2 h,requiring endotracheal extubation after surgery,were randomly divided into 3 group(n=30 each):control group(group C),exmedetomidine administered intratracheally group(group D1)and dexmedetomidine administered intravenously group(group D2). At the beginning of operation,2 μg/kg of dexmedetomidine were infused intratracheal through the drug injection hole of disposable enhanced Ⅲ endotracheal tube in group D1 and 0.5 μg/kg of dexmedetomidine were intravenous pumped in 10 minutes in group D2,while saline was used in group C. The patients were sent to postanesthesia care unit after extubaion. MAP and HR were recorded at the time of dexmedetomidine or saline infused(T_0),and 5,10,15,30 min(T_2-T_4)after dexmedetomidine or saline infused,immediately after extubation(T5),and 5,10,15,30 min(T_6-T_9)after extubation. The time of the patients to recover spontaneous breath,eye opening,extubation and directional power were recorded. The cough reflex scores and sedation-agitation scale during extubation,the visual analogue scale and Ramsay sedation scale at 30 minutes after extubation were also recorded.【Results】(1) Compared with T_0,MAP and HR increased statistically at T_5~T_7 in group C,MAP increased statistically at T_5~T_6 and HR increased statistically at T_5~T_7 in group D1 and D2(P<0.05). Compared with group C,MAP and HR at T_5~T_7 decreased statistically in group D1 and D2(P<0.05).(2) The scores of cough reflex,sedation-agitation scale and visual analogue scale were significantly lower in group Dl and D2 than in group C(P<0.5).(3) The incidence of agitation,high blood pressure and tachycardia were significantly lower in group D1 and D2 than in group C(P<0.05).【Conclusions】Either intravenous pumping or intratracheal instillation of dexmedetomidine for patients undergoing gynecological laparoscopic surgery can effectively keep stable perioperative hemodynamics,relieve cough reflex,agitation incidence and enhance the quality of emergence from general anesthesia recovery.