右美托咪定不同用法预防输尿管镜碎石术后全麻苏醒期躁动的效果比较

Comparison of the effect of different methods of dexmedetomidine in prevention of emergence agitation after ureteroscopic lithotripsy by general anesthesia

目的比较右美托确定不同用法预防输尿管镜碎石术后全麻苏醒期躁动(EA)的效果。方法选择2019年1月至2019年12月撒于全麻下行输尿管镜碎石术的患者200例,采用随机数字表法分为四组,每组各50例。麻醉前10 min,D1组按0.5μg.(kg·h)^(-1)的速度静脉输往右美托咪定至术毕前30 min;D2组给予右美托咪定0.8μg/kg的负荷剂量,10 min内输完,然后以0.5μg.(kg·h)^(-1)的速度维持至术毕前30 min;D3组仅给予右美托咪定0.8 pg/kg的负荷剂量,10 min内输究;C组不使用右美托账定。记录麻醉前10 min(T0)、麻醉后20 min(T1).术毕(T2)及拔除喉翠后10 min(T3)的心率(HR)罕均动脉压(MAP)。比较苏醒时间及低血压、心动过缓,EA发生率,阿托晶,甲氧明用量及输液量。结果在T1时间点。D1组和C组的HR、MAP明显高于D2,D3组(P<0.05);在T2、T3时间点,D1、C组的HR、MAP离于D2组(P<0.05)。C组的EA发生率明显高于D1、D2、D3组(P<0.05);D1组的低血压和心动过级发生率低于D2和D3组(P<0.05);D1、D2、D3组的EA发生事比较,差异无统计学意义(P>0,05)。DI组的阿托品、甲氧明用量及输液量明显低于D2、D3组(P<0.05)。结论麻醉前10 min开始静脉输注0.5μg.(kg·h)^(-1)的右美托眯定,并持续输注至术毕前30 min,可有效预防EA,不延迟苏疆时间。且血德动力学稳定,安全性更高,具有临床应用价值。

To compare the effects of different methods of dexmedetomidine in prevention of e-mergence agitation(EA).Methods From January 2019 to December 2019,200 patients scheduled for ureteroscopic lithotripsy by general anesthesia were randomly divided into four groups.At 10 mi-nutes before induction of anesthesia,group D1 received dexmedetomidine at the rate of 0.5μg.(kg·h)^(-1) until 30 minutes before the end of operation,group D2 and D3 received the dexmedetomi-dine loading dosage of 0.8μg/kg in 10 minutes.Then group D3 continued to infuse dexmedetomidine attherateof0.5μg.(kg·h)^(-1) until 30 minutes before the end of operation.Group C did not use.dexmedetomidine.MAP and HR at 10 minutes before induction of anesthesia(T0),at 20 minutes after induction of anesthesia(T1),at the end of surgery(T2)and at 10 minutes after removing the la-ryngeal mask(T3)were recorded.The recovery time,the incidence of low blood pressure,bradycar-dia,EA and use of atropine,methoxamine,and infusion were recorded.Results The incidence of EA in group C was significant higher than other groups(P<0.05).The incidence of EA was no significant difference in group D1,D2 and D3(P>0.05).At T1,MAP and HR in group D1 were higher than group D2 and D3(P<0.05).The incidence of low blood pressure and bradycardia in group D1 was lower than group D2 and D3(P<0.05),and no significant difference between group D1 and group C(P>0.05).The use of atropine,methoxamine and infusion in group D1 was lower than group D2 and D3(P<0.05),and no significant difference between group D1 and group C(P>0.05).Conclusions At 10 minutes before induction of anesthesia,dexmedetomidine continuously infused with the rate of0.5μg.(kg·h)^(-1)until 30 minutes before the end of operation is the most suitable to prevent emergence agitation,which has the least inhibition on respiration and hemodynamics.