不同麻醉方法下脊柱侧弯矫形术患者术中唤醒试验效果的比较

Comparison of intraoperative wake-up test performed under different methods of anesthesia in patients undergoing scoliosis correction

目的比较不同麻醉方法下脊柱侧弯矫形术患者术中唤醒试验的效果。方法择期行脊柱侧弯矫形术患者60例，性别不限，年龄14-35岁，ASA分级Ⅰ或Ⅱ级，采用随机数字表法分为2组（n＝30）：右美托咪定复合麻醉组（D组）和七氟醚复合麻醉组（S组）。静脉麻醉诱导后，行气管插管术；麻醉维持：静脉泵注瑞芬太尼0.3 μg·kg^－1·min^－1，D组静脉泵注右美托咪定0.2 μg·kg^－1·h^－1，S组持续低流量吸入七氟醚1 L/min，维持呼气末浓度0.8%-1.5%。维持Narcotrend指数值30-45。记录唤醒时间、唤醒期间不良事件发生情况、血管活性药物使用情况和出血量，评估唤醒质量。结果2组患者术中唤醒试验均成功。与S组比较，D组唤醒质量升高，唤醒期间躁动、严重呛咳发生率降低，出血量减少（P〈0.05），唤醒时间和血管活性药物使用率差异无统计学意义（P〉0.05）。结论右美托咪定复合麻醉下脊柱侧弯矫形术患者术中唤醒试验的效果优于七氟醚复合麻醉。

Objective To compare the intraoperative wake-up test performed under different methods of anesthesia in the patients undergoing scoliosis correction.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 14-35 yr, undergoing elective scoliosis correction, were divided into dexmedetomidine-based anesthesia group（D group）and sevoflurane-based anesthesia group（S group）, with 30 cases in each group.Patients were tracheally intubated after induction of anesthesia.Maintenance of anesthesia was as follows： remifentanil 0.3 μg·kg-1·min-1 was intravenously infused, dexmedetomidine 0.2 μg·kg-1·h-1 was intravenously infused in group D, and group S inhaled low flow sevoflurane 1 L/min with the end-tidal concentration of 0.8%-1.5%.Narcotrend index value was maintained at 30-45.The wake-up time, adverse events, requirement for vasoactive agents and blood loss during wake-up test were recorded.The wake-up quality was evaluated.Results All the patients successfully completed wake-up tests.Compared with group S, the wake-up quality was significantly increased, the incidence of agitation and bucking was decreased during wake-up test, the blood loss was reduced during wake-up test（P〈0.05）, and no significant change was found in wake-up time or requirement for vasoactive agents in group D（P〉0.05）.Conclusion Dexmedetomidine-based anesthesia produces better efficacy for intraoperative wake-up test than sevoflurane-based anesthesia in the patients undergoing scoliosis correction.