右美托咪定对口腔癌术后患者留置气管导管耐受性的影响

Effect of Dexmedetomidine on Tracheal Catheter Tolerance in Patients with Oral Cancer Surgery

目的:探讨右美托咪定对口腔癌术后患者留置气管导管耐受性的影响。方法:选取口腔癌手术患者80例,随机分为正常对照组(N组)和右美托咪定组(D组),每组各40例。2组均行常规麻醉诱导和维持,D组于麻醉诱导前给予1μg/kg负荷剂量的右美托咪定,术中泵注0.2~0.6μg/(kg·h)右美托咪定维持麻醉,术毕镇痛泵内给予1μg/kg剂量的右美托咪定;N组右美托咪定的负荷量、维持量及镇痛泵中的用量均用等量0.9%氯化钠溶液代替。记录术后12 h内2组患者Ricker镇静-躁动评分(Ricker sedation agitation score,SAS)及呛咳、躁动和自行拔管的发生率;记录围术期血糖水平;记录低氧血症和血流动力学情况。结果:与N组相比,D组术后2、6 h时的SAS评分低(P<0.05),术后12 h内呛咳、躁动发生率,高血压、心动过速发生率低,而心动过缓发生率高(P<0.05),围手术期的血糖水平低(P<0.05)。2组术后12 h时的SAS评分,术后12 h内的自行拔管率、低氧血症及低血压发生率差异无统计学意义(P>0.05)。结论:口腔癌手术患者于围术期使用右美托咪定能够增加术后留置气管导管的耐受性,降低围术期血糖水平,稳定血流动力学,但是要警惕心动过缓的发生。

Objective:To evaluate the effect of dexmedetomidine on postoperative tracheal catheter tolerance in patients with oral cancer surgery.Methods:A total of eighty oral cancer patients who had undergone tumor resection surgery were randomly divided into normal control group(group N)and dexmedetomidine group(group D)with forty patients in each group.Standard anesthesia induction and maintenance were performed in both groups.Patients in group D were intravenously administered a bolus of 1μg/kg dexmedetomidine before anesthesia induction,and then continuous infusion of 0.2-0.6μg/(kg·h)dexmedetomidine during operation.After operation,the patient-controlled analgesia(PCA)pumps,which contained 1μg/kg dexmedetomidine were used through venous way.In group N,the same amount of 0.9%sodium chloride solution were intravenously administered before,during and after surgery.Ricker sedation agitation score(SAS),the incidence of bucking,dysphoria and self-extubation in both groups were recorded for 12 hours postoperatively.The perioperative level of blood glucose was recorded.Hypoxaemia and hemodynamics change after operation were recorded.Results:Compared with group N,patients in group D had a lower SAS at 2 hour and 6 hour after operation(P<0.05).The incidence of bucking,dysphoria,tachycardia and hypertension 12 hours after operation were significantly lower in group D than in group N(P<0.05).However,patients in group D had a higher incidence of bradycardia compared with group N 12 hours after operation(P<0.05).The perioperative level of blood glucose in group D was lower than that in group N(P<0.05).The SAS at 12 hour after operation,the incidence of self-extubation,hypoxaemia and hypotension had no statistical difference between the two groups.Conclusion:Perioperative intravenous injection of dexmedetomidine could improve tracheal catheter tolerance,decrease blood glucose and stabilize hemodynamics in patients with oral cancer surgery.However,we should be cautious of the incidence of bradycardia.