右美托咪定对脊柱骨折手术全身麻醉患者围拔管期血流动力学及苏醒过程的影响

Effect of Dexmedetomidine on hemodynamics and resuscitation during peri-extubation in patients undergoing general anesthesia for spinal frac-ture surgery

目的观察右美托咪定对脊柱骨折手术全身麻醉患者围拔管期血流动力学及苏醒过程的影响。方法选取2017年2月~2018年8月我院接收的94例行脊柱骨折手术治疗患者作为研究对象,根据随机数字表法将其分为观察组(n=47)和对照组(n=47)。对照组患者给予生理盐水泵注进行麻醉,观察组患者给予右美托咪定泵注进行麻醉。比较两组患者不同时刻[全麻诱导前(T1)、拔管时(T2)及拔管5min后(T3)]的血流动力学指标[收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)及心率(HR)]、苏醒各指标(呼吸恢复时间、按指令睁眼时间、拔除气管时间)及不良反应发生情况。结果两组患者T1的血流动力学各指标比较,差异无统计学意义(P>0.05);两组患者T2、T3的血流动力学指标均高于T1,差异有统计学意义(P<0.05);观察组患者T2、T3的血流动力学指标均明显低于对照组,差异有统计学意义(P<0.05)。观察组患者的呼吸恢复时间、按指令睁眼时间、拔除气管时间均明显短于对照组,差异有统计学意义(P<0.05)。观察组患者的不良反应总发生率为2.13%,显著低于对照组的46.81%,差异有统计学意义(P<0.05)。结论右美托咪定用于脊柱骨折手术全身麻醉患者,有利于稳定围拔管期血流动力学,同时能够缩短苏醒期时间,显著降低不良反应发生率,临床效果显著,值得推广。

Objective To observe the effect of Dexmedetomidine on hemodynamics and resuscitation during peri-extubation in patients undergoing general anesthesia for spinal fracture surgery. Methods A total of 94 patients receiving surgical treatment for spinal fracture from February 2017 to August 2018 were selected as study subjects, and they were divided into the observation group (n=47) and the control group (n=47) according to the random number table method. Patients in the control group were given saline pump injection for anesthesia, and patients in the observation group were given Dexmedetomidine injection for anesthesia. The hemodynamic indexes (systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP] and heart rate [HR]) at different times (before induction of general anesthesia [T1], at extubation time [T2] and 5 min after extubation [T3]), resuscitation indexes (respiratory recovery time, the time to open eyes by instruction and tracheal extubation time) and the incidence of adverse reactions were compared between the two groups. Results There were no significant differences in hemodynamic indexes between the two groups at T1 (P>0.05). The hemodynamic indexes at T2 and T3 in both groups were higher than those at T1, and the differences were statistically significant (P<0.05). The hemodynamic indexes at T2 and T3 in the observation group were lower than those in the control group, and the differences were statistically significant (P<0.05). The respiratory recovery time, the time to open eyes by instruction and the tracheal extubation time in the observation group were significantly shorter than those in the control group, and the differences were statistically significant (P<0.05). The total incidence rate of adverse reactions was 2.13% in the observation group, which was significantly lower than that in the control group (46.81%), and the difference was statistically significant (P<0.05). Conclusion Dexmedetomidine can stabilize the hemodynamics in peri-extubation period, shorten the waking period, significantly reduce the incidence rate of adverse reactions, and has significant clinical effect in patients undergoing general anesthesia for spinal fracture surgery, which is worthy of promotion.