右美托咪啶联合丙泊酚对食管癌根治术患者术后躁动的影响

Effects of dexmedetomidine combined with propofol on emergence agitation in patients undergoing esophagectomy

目的观察右美托咪啶联合丙泊酚对开胸食管癌根治术患者苏醒期躁动的影响。方法选择2018年1月至2019年8月间在中国科学技术大学附属第一医院西区择期行开胸食管癌根治术术后苏醒期发生躁动的患者50例,以随机数表法将患者分为丙泊酚组(P组)和丙泊酚+右美托咪啶组(D组),每组25例,P组患者单纯给予丙泊酚,首剂量0.5~1 mg/kg,之后根据情况可多次给药,D组患者则给予丙泊酚与右美托咪啶,首剂量丙泊酚0.5~1 mg/kg,随后泵注右美托咪啶0.5μg/kg(5~10 min),之后根据情况可追加丙泊酚。目标镇静范围Richmond烦躁-镇静评分(RASS)-2^+1分。所有患者根据疼痛评分给予羟考酮镇痛。分别记录两组患者不同时点的血压(MAP)、心率(HR)和血氧饱和度(SpO2),统计两组患者拔管后各时点达到RASS目标分值的比例,同时记录丙泊酚及羟考酮总使用量,记录第一次给药至拔管时间及恢复室停留时间。结果D组与P组患者在拔管时的HR[(59.9±5.5)次/min vs(87.6±9.1)次/min]、MAP[(80.6±7.8)mmHg vs(95.3±8.7)mmHg]比较,D组明显低于P组,拔管后5 min HR[(61.7±5.7)次/min vs(75.6±7.1)次/min]比较,D组明显低于P组,差异均有统计学意义(P<0.05),而拔管后5 min的MAP[(78.2±7.4)mmHg vs(82.2±8.2)mmHg]比较差异无统计学意义(P>0.05);D组与P组患者的丙泊酚用量[(51.5±15.6)mg vs(113.2±22.6)mg]、羟考酮用量[(3.8±0.8)mg vs(4.3±0.8)mg],第1次用药至拔管时间[(13.5±1.4)min vs(15.5±4.0)min]、第1次用药至出恢复室时间[(38.2±7.6)min vs(47.0±14.5)min]及恢复室总停留时间[(43.2±7.6)min vs(51.9±15.2)min]比较,D组明显小于P组,差异均有统计学意义(P<0.05)。结论右美托咪啶联合丙泊酚用于术后苏醒期发生躁动的食管癌患者,可减少镇静及镇痛药的使用量,缩短患者的拔管时间及恢复室停留时间。

Objective To evaluate the effect of dexmedetomidine combined with propofol on emergence agitation in patients undergoing esophagectomy.Methods Fifty patients with emergence agitation undergoing elective esophagectomy in The First Affiliated Hospital of University of Science and Technology of CHINA from January 2018 to August 2019 were randomly divided into two groups(n=25 each):propofol group(group P),dexmedetomidine combined with propofol group(group D).Group P only received propofol,and group D received dexmedetomidine and propofol:the first dose of propofol was 0.5-1 mg/kg,followed by dexmedetomidine 0.5μg/kg,and then propofol was added according to the RASS score.The RASS score was maintained in the range of-2 to 1.Both groups were treated with oxycodone for pain relief based on pain scores.The hemodynamic parameters(blood pressure[MAP],heart rate[HR],and oxygen saturation[SpO2]),the proportion of patients reaching the target RASS score,propofol and oxycodone consumptions,the time of extubation,and post anesthesia care unit(PACU)stay time were recorded.Results Compared with that in group P,patients in group D have lower HR and MAP at T3,and lower HR at T4(P<0.05):HR at T3,(59.9±5.5)beats/min vs(87.6±9.1)beats/min;MAP at T3,(80.6±7.8)mmHg vs(95.3±8.7)mmHg;HR at T4,(61.7±5.7)beats/min vs(75.6±7.1)beats/min.Propofol and oxycodone consumptions,the time of extubation,and PACU stay were reduced in group D(P<0.05):(51.5±15.6)mg vs(113.2±22.6)mg;(3.8±0.8)mg vs(4.3±0.8)mg;(13.5±1.4)min vs(15.5±4.0)min;(43.2±7.6)min vs(51.9±15.2)min.Conclusion Dexmedetomidine combined with propofol used in patients with emergence agitation undergoing elective esophagectomy can reduce the sedative and analgesic drugs consumptions,and shorten the time of extubation and PACU stay.