咪唑安定与右美托咪定对全麻严重烧伤切痂植皮术患者苏醒期躁动影响的比较

Comparison of the effects of midazolam and dexmedetomidine on restlessness during recovery in general anesthesia patients with severe burn and escharectomy and skin grafting

目的比较咪唑安定与右美托咪定对全麻严重烧伤切痂植皮术患者苏醒期躁动的影响。方法选择2017年1～12月我院行全麻严重烧伤切痂植皮术40例,按照随机数字表法分为对照组和实验组。对照组患者诱导前15min静注咪唑安定0.05mg/kg,诱导插管后持续泵注咪唑安定0.5μg/(kg·min)至手术结束前30min;实验组患者诱导前15min静脉泵注右美托咪定1μg/kg,诱导插管后持续泵注右美托咪啶0.4μg/(kg·h)至手术结束前30min。分别评估两组患者麻醉苏醒过程中4个时间点的血流动力学指标的变化,苏醒后躁动情况及不良反应,其中血流动力学指标包括心率、平均动脉压和脉搏氧饱和度。结果麻醉诱导前(T0)两组患者的心率、平均动脉压均差异无统计学意义(P> 0.05),但气管拔管前(T1)、气管拔管后即刻(T2)、拔管后5min(T3)对照组患者的心率、平均动脉压较麻醉诱导前(T0)显著升高,差异有统计学意义(P <0.05),且均显著高于同时间点实验组患者,差异有统计学意义(P <0.05);两组患者在四个时间点的脉搏氧饱和度差异无统计学意义(P> 0.05);实验组患者躁动分级显著低于对照组患者,差异有统计学意义(P<0.05);实验组患者不良反应寒战发生率低于对照组,差异有统计学意义(P<0.05)。结论本研究结果显示,右美托咪定可以更好的稳定全麻苏醒期的心血管反应,使拔管过程更加平稳,有效减少苏醒期躁动且不良反应较少。

Objective To compared the effect of midazolam and dexmedetomidine on restlessness during recovery in general anesthesia patients with severe burn and esehareetomy and skin grafting. Methods Forty anesthesia severe burn patients with esehareetomy and skin grafting in our hospital from January 2017 to December 2017 were selected,and divided into the control group and experimental group according to the random number table method.Patients in the control group were given intravenous midazolam 0.05mg/kg 15min before induction,after intubation induction,continuous injected midazolam 0.5μg/（kg·min） to 30min before the end of operation.Patients in the experimental group were given intravenous dexmedetomidine 1μg/kg 15min before induction,continuous injected dexmedetomidine 0.4μg/（kg·h） to 30min before the end of operation.The changes of hemodynamie indexes,restlessness and adverse reactions were evaluated at 4 time points during anesthesia recovery in the two groups.The hemodynamie indexes included heart rate,mean arterial pressure and pulse oxygen saturation. Results There was no significant difference in heart rate and mean arterial pressure between the two groups before anesthesia induction （ T0 ） （P 〉 0.05）.However,the heart rate and mean arterial pressure in the control group before tracheal extubation （T1）,immediately after tracheal extubation （T2） and 5 minutes after extubation （T3） were significantly higher than those before induction of anesthesia （T0）,and the difference was statistically significant （P 〈 0.05）,and significantly higher than the same time point in the experimental group,the difference was statistically significant （P 〈 0.05）.There was no significant difference in pulse oxygen saturation between the two groups at 4 time points （P〉 0.05）.The restlessness rating of the experimental group was significantly lower than that of the control group （P〈 0.05）. The incidence of adverse reactions chills in the experimental group was lower than that in the control group,and the difference was statistically significant （P 〈 0.05）. Conclusion The results of this study show that dexmedetomidine can better stabilize the cardiovascular response during the recovery period of general anesthesia,make the process of extubation more stable,effectively reduce the agitation period and less adverse reactions.