右美托咪定与丙泊酚用于甲状腺腺瘤次全切除术后患者苏醒质量的比较

Comparison of dexmedetomidine and propofol on the recovery quality under general anesthesia in thyroidectomy

目的比较右美托咪定与丙泊酚在甲状腺腺瘤次全切术后持续输注情况下,患者拔管时心血管的稳定性和术后苏醒质量。方法选择择期行甲状腺腺瘤次全切除术患者120例,男24例,女96例,年龄25~64岁,BMI 19.0~28.0kg/m2,ASAⅠ或Ⅱ级。将患者随机分为两组:右美托咪定组(D组)和丙泊酚组(P组),每组60例。术毕转运至PACU后,D组给予4μg/ml右美托咪定0.5μg·kg^(-1)·h^(-1),泵注时间≥20min,持续输注至甲状腺快速切片病理结果为阴性,停药等待患者苏醒后拔管;P组给予丙泊酚2.5mg·kg^(-1)·h^(-1),同样等待结果为阴性后停药。记录睁眼时间和拔管时间;记录拔管前和拔管后自主呼吸状态下PaCO_2;评价苏醒时躁动程度(RS)评分和Ramsay镇静评分,记录拔管时躁动、呛咳、恶心呕吐和血压下降等不良反应的发生情况。结果 P组拔管时间明显长于D组(P<0.05)。两组睁眼时间和拔管前PaCO_2差异无统计学意义。D组拔管后PaCO_2明显高于P组(P<0.05),但处于正常范围,未观察到CO_2蓄积的情况。与P组比较,D组苏醒时RS评分明显降低,Ramsay镇静评分明显升高,拔管时躁动和呛咳发生率明显降低(P<0.05)。两组恶心呕吐、血压下降发生率差异无统计学意义。结论右美托咪定和丙泊酚比较,能使甲状腺腺瘤次全切除术患者术后带管期间的血流动力学更稳定,预防甲状腺全麻手术患者苏醒期间躁动,且未观察到CO_2蓄积,拔管不良反应少,能明显提高患者术后苏醒质量。

Objective To make comparison of the vascular stability and recovery quality of patients during extubation before a continuous infusion of dexmedetomidine or propofol after thyroidectomy.Methods A total of 120 patients scheduled for thyroidectomy,24 males and 96 females,aged25-64 years,BMI 19.0-28.0 kg/m^2,ASA physical statusⅠ orⅡ,were divided into two groups（60 in each）.After the operation,patients were sent to the PACU where group D received dexmedetomidine 0.5μg·kg^-1·h^-1（4μg/ml,≥ 20 min）and group P received propofol 2.5 mg·kg^-1·h^-1 intravenously until the pathological report was negative so that they could be extubated.The time of eye opening and extubation after drug administration was observed.Arterial pressure of carbon dioxide（PaCO2）before and after extubation were recorded as well as restlessness score（RS）and Ramsay sedative score.Events during extubation including agitation,cough,nausea and vomiting,drop of BP were also recorded.Results Patients in group P need more time to be intubated than that in group D（P〈0.05）.There was no statistical differencein time of eye opening and PaCO2 before patients be intubated between the two groups.After being intubated,patients in group D were observed a higher PaCO2 than that in group P（P〈0.05）,while the data was in a normal range and no CO2 accumulation was observed.Group D showed lower RS and higher Ramsay sedative scores than that in group P（P〈0.05）.More patients coughed and suffered agitation in group P while most patients stayed quiet in group D（P〈0.05）.There was no significant difference in the incidence of nausea,vomiting and drop of BP between the two groups.Conclusion Patients under a continuous infusion of dexmedetomidine after thyroidectomy have a more stable hemodynamic status during extubation rather than restlessness and agitation compared with patients with propofol.No stimulation of CO2,respiratory depression and other events are observed during extubation,thus that dexmedetomidine provides a higher quality of recovery in PACU in patients undergoing thyroidectomy.