盐酸右美托咪定联合盐酸羟考酮对腹部闭合性损伤手术患者苏醒质量的影响

Effect of Dexmedetomidine Hydrochloride Combined with Oxycodone Hydrochloride on Recovery Quality in Patients with Abdominal Blunt Trauma

目的探讨盐酸右美托咪定联合盐酸羟考酮对腹部闭合性损伤行急诊开腹手术患者全麻苏醒期的苏醒质量和应激反应的影响。方法选择胃肠肝胆科急诊行开腹手术患者60例,随机分成治疗组和对照组各30例。治疗组患者于麻醉诱导完成后缓慢静脉滴注或泵入盐酸右美托咪定1μg·kg-1、盐酸羟考酮0.1 mg·kg-1,15 min内滴完;对照组滴入等体积0.9%氯化钠注射液。记录麻醉诱导前(t0)、拔管即刻(t1)、拔管结束后1 min(t2)、拔管结束后10 min(t3)、拔管结束后30 min(t4)时点收缩压(SBP)、舒张压(DBP)和心率(HR);评价患者自主呼吸恢复时间、患者苏醒时间及拔管时间;观察记录患者t1、t2、t3、t4时点视觉模拟评分(VAS)、躁动评分、镇静评分(Ramsay)等;观察药物不良反应;检测t0、t1、t3、t4时点皮质醇(Cor)、肾上腺素(E)、去甲肾上腺素(NE)血浆浓度和血糖(Glu)浓度。结果治疗组在t1、t2、t3时SBP、DBP、HR较对照组显著降低(P<0.01);两组自主呼吸恢复时间、苏醒时间、拔管时间均差异无统计学意义(P>0.05);治疗组患者在t2、t3、t4时VAS评分、躁动评分明显低于对照组(P<0.01),两组患者所有时间点Ramsay评分比较差异无统计学意义(P>0.05);两组患者恶心、呕吐、心律失常、困倦发生率相似,且均未发生呼吸抑制和皮肤瘙痒(P>0.05);t1、t3及t4时血浆Cor、E、NE、Glu浓度较t0均显著升高(P<0.01);治疗组Cor、E、NE、Glu血浆浓度在t1、t3及t4时较对照组显著降低(P<0.01)。结论盐酸右美托咪定联合盐酸羟考酮超前镇痛,可为开腹手术患者提供更稳定血流动力学环境,减轻疼痛反应及躁动发生程度,减轻拔管期应激反应。

Objective To investigate the effect of dexmedetomidine hydrochloride combined with oxycodone hydrochloride on the recovery quality and stress response of patients during general anesthesia recovery period after emergency abdominal surgery for abdominal blunt trauma.Methods A total of 60 patients undergoing emergency open surgery was selected and randomly divided by 30 cases each into treatment group and control group.After the induction of anesthesia,the patients in the treatment group were intravenously infused or pumped with dexmedetomidine hydrochloride(1μg·kg-1)and oxycodone hydrochloride(0.1 mg·kg-1)within 15 minutes.The control group was infused with an equal volume of 0.9%sodium chloride solution.Systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)were recorded before induction of anesthesia(t0),extubation immediately(t1),1 minute after extubation(t2),10 minutes after extubation(t3),and 30 minutes after extubation(t4).The recovery time of spontaneous breathing,resuscitation time and extubation time were evaluated,and the visual analogue scale(VAS),restlessness score,sedation score(Ramsey)were recorded at the time of t1,t2,t3,and t4.Adverse drug reactions were observed and plasma cortisol(Cor),epinephrine(E),norepinephrine(NE),blood glucose concentration(Glu)concentrations were determined at t0,t1,t3 and t4.Results Compared with the control group,the SBP,DBP and HR measured at t1,t2 and t3 time points in the treatment group were significantly lower(P<0.01).There was no significant differences in recovery time,resuscitation time and extubation time between the two groups(P>0.05).The VAS scores and RSS scores of the treatment group at t2,t3,and t4 were significantly lower than those of the control group(P<0.01).There was no significant difference in Ramsay scores between the two groups at all time points(P>0.05).The incidences of nausea,vomiting,arrhythmia and drowsiness were similar in both groups,and there were no respiratory depression and pruritus(P>0.05).At the t1,t3 and t4 time points,plasma Cor,E,NE,and Glu concentrations were significantly higher than those at t0(P<0.01).In the treatment group,plasma concentrations of Cor,E,NE,and Glu at t1,t3,and t4 were significantly lower than those of the control group(P<0.01).Conclusion The combined use of dexmedetomidine hydrochloride and oxycodone hydrochloride for advanced anesthesia could provide more stable hemodynamic environment for patients undergoing open surgery to relieve the pain reaction and the degree of restlessness,and reduce stress response during extubation.