精神分裂症患者右美托咪定静脉复合麻醉临床观察

Clinical observation of dexmedetomidine intravenous combined anesthesia in patients with schizophrenia

目的评价右美托咪定用于精神分裂症患者全身麻醉手术的临床效果。方法选择择期手术精神分裂症患者60例,美国麻醉协会(American Society of Anesthesiologists,ASA)分级Ⅰ~Ⅱ级,均有长期服用抗精神病药物史。按照随机数字表法分为右美托咪定组(Dex组)和对照组(NS组)各30例。2组均于气管插管全身麻醉下手术,Dex组于全身麻醉诱导前10 min内静脉注射右美托咪定1.0μg/kg,随后以0.4μg·kg^-1·h^-1持续输注至手术结束,对照组输注等容量生理盐水。记录麻醉诱导前(T1)、气管插管即刻(T2)、切皮时(T3)、手术结束时(T4)的平均动脉压(mean artery pressure,MAP)。采集2组麻醉诱导前(T1)、切皮时(T3)、手术结束时(T4)外周静脉血,检测皮质醇(cortisol,Cor)、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、白细胞介素6(interleukin-6,IL-6)、白细胞介素10(interleukin-10,IL-10)水平,评价拔除气管插管后10 min(T5)、拔管后20 min(T6)时Ramsay镇静评分(Ramsay Sedative Score,RSS)和躁动评分(Restlesshess Score,RS)。结果Dex组MAP水平呈先降低后升高趋势,NS组MAP水平逐渐升高,Dex组MAP水平低于NS组,其组间、时点间、组间·时点间交互作用差异均有统计学意义(P<0.05)。2组Cor、hs-CRP、TNF-α、IL-6、IL-10水平均明显升高,Dex组Cor、CRP、TNF-α、IL-6水平低于NS组,IL-10水平高于NS组,其组间、时点间、组间·时点间交互作用差异均有统计学意义(P<0.05)。Dex组T5、T6时点RSS高于NS组,RS低于NS组,差异有统计学意义(P<0.05)。结论右美托咪定能够维持精神病患者围手术期循环稳定,保证苏醒期良好镇静;可有效控制患者围术期应激水平,减少免疫炎症因子释放,减少术后苏醒期躁动,确保患者围术期的精神症状更趋稳定,值得推广应用。

Objective To evaluate the clinical effect of dexmedetomidine(Dex)in general anesthesia in patients with schizophrenia.Methods Sixty patients with schizophrenia undergoing elective surgery,American Society of Anesthesiologists(ASA)grade Ⅰ~Ⅱ,had a history of taking antipsychotic drugs for a long time.According to the method of random digital table,the patients in the two groups were randomly divided into two groups:Dex group(n=30)and control group(n=30).The patients in the two groups were operated under general anesthesia with endotracheal intubation.Dex group was injected intravenously with dexmetomide 1.0 ug/kg,10 min before general anesthesia induction and then continued infusion with 0.4μg·kg^-1·h^-1 until the end of the operation,and the control group was infused with saline of the same volume.The mean arterial pressure(mean artery pressure,MAP)was recorded before anesthesia induction(T1),immediately after endotracheal intubation(T2),at the time of skin incision(T3)and at the end of operation(T4).Peripheral venous blood samples were collected before anesthesia induction(T1),during skin incision(T3)and at the end of operation(T4).Cortisol(Cor),high sensitive C-reactive protein(hs-CRP),tumor necrosis factorα(TNF-α),interleukin-6(IL-6)and interleukin-10(IL-10)were measured,and 10 min(T5)after tracheal intubation was evaluated.Ramsay Sedation Score(RSS)and Restlessness Score(RS)at 20 min(T6)after extubation.Results The level of MAP in Dex group decreased at first and then increased,the level of MAP in NS group increased gradually,and the level of MAP in Dex group was lower than that in NS group.There was significant difference in the interaction between groups,time points and time points.The levels of Cor,hs-CRP,TNF-α and IL-6,IL-10 in Dex group were significantly higher than those in NS group,and the level of IL-10 in Dex group was higher than that in NS group.The RSS of Dex group was higher than that of NS group,and the RS of T5 and T6 group was significantly lower than that of NS group(P<0.05).Conclusion Dexmetomide can maintain the perioperative circulation stability of psychotic patients,ensure good sedation during recovery,effectively control the perioperative stress level of patients,reduce the release of immune inflammatory factors,reduce restlessness during postoperative recovery,and ensure that the perioperative mental symptoms of patients are more stable,which is worth popularizing and applying.