右美托咪定对颌面整形手术全麻苏醒期躁动的影响研究

Influence of Dexmedetomidine on Emergence Agitation after Maxillofacial Plastic Surgery under General Anesthesia

目的:探讨右美托咪定对颌面整形手术全身麻醉患者苏醒期躁动的影响。方法:选择笔者医院2017年1月-2017年12月行颌面整形手术全麻患者60例,采用随机数字表法,将患者随机分为右美托咪定组和生理盐水对照组,每组30例。右美托咪定组在全麻诱导开始前15min内,静脉泵注0.5μg/kg右美托咪定,术中继续以0.34～0.4μg/kg/h维持泵注;生理盐水对照组静脉泵注等量的生理盐水。记录麻醉前基础值(T_0)、吸痰时(T_1)、拨管时(T_2)、拔管后15min(T_3)时的MAP、HR。记录T_2、T_3时躁动发生情况和T_3时Ramsay镇静评分,同时记录丙泊酚、舒芬太尼的用量,麻醉时间、手术时间,苏醒时间及不良反应情况。结果:两组患者性别、年龄、体重、麻醉时间、手术时间、苏醒时间比较,差异无统计学意义(P>0.05)。右美托咪定组丙泊酚、舒芬太尼用量少于生理盐水对照组,且右美托咪定组T_3时Ramsay镇静评分高于生理盐水对照组,差异均有统计学意义(P<0.05)。两组T_0、T_3时点的MAP、HR比较,差异无统计学意义(P>0.05);右美托咪定组T_1、T_2时点的HR、MAP明显低于生理盐水对照组,差异有统计学意义(P<0.05)。右美托咪定组仅发生轻度躁动1例,无中、重度躁动发生,躁动发生率为3.3%;生理盐水对照组发生中度2例,重度3例,发生率为16.7%,差异有统计学意义(P<0.05)。结论:低剂量右美托咪定持续静脉泵注对颌面整形手术患者全麻苏醒期躁动有显著的防治作用,并且能维持稳定的血流动力学,不延长苏醒时间。

Objective To investigate the infuence of dexmedetomidine on emergence agitation of patients after maxillofacial plastic surgery under general anesthesia. Methods 60 cases of patients treated with maxillofacial plastic surgery under general anesthesia in our hospital from January 2017 to December 2017 were selected and randomly divided into the two groups, the dexmedetomidine group and the normal saline control group according to the random number table, 30 cases in each group. Within 15min prior to the general anesthesia induction, the dexmedetomidine group was given 0.5μg/kg dexmedetomidine by intravenous pumping, and such intravenous pumping was maintained at 0.34-0.4μg/kg/h during surgery. The normal saline control group was given an equal amount of normal saline by intravenous pumping. Pre-anesthesia baseline value （T0）, MAP and HR during sputum aspiration （T1）, during extubation （T2） and 15min after extubation （T3） were recorded. The rate of agitation at T2 and T3 and Ramsay score at T3 were recorded, and the dosages of propofol and sufentanil, duration of anesthesia, duration of surgery, recovery time and adverse reaction were also recorded. Results There was no signifcant difference in sex, age, weight, anesthesia time, operation time and recovery time between the two groups（P〉0.05）. The dosage of propofol and sufentanil in dexmedetomidine group was lower than that in the normal saline control group, and the Ramsay sedation score at T3 in the dexmedetomidine group was higher than that in the normal saline control group, the differences were statistically significant（P〈0.05）. There were no significant difference in MAP and HR between the two groups at T0 and T3（P〉0.05）. The HR and MAP of T1 and T2 in the dexmedetomidine group were signifcantly lower than those in the normal saline control group（P〈0.05）. In the dexmedetomidine group, only 1 case had mild restlessness, no moderate or severe restlessness, the incidence of restlessness was 3.3%. and in the normal saline control group, 2 cases had moderate and 3 cases had severe restlessness, the incidence was 16.7%, the difference was statistically signifcant（P〈0.05）. Conclusion The continuous intravenous pumping of low-dosage dexmedetomidine has significant preventive and therapeutic effects on emergence agitation of patients after maxillofacial plastic surgery under general anesthesia, and it can maintain the stable hemodynamics, without prolonging the recovery time.