右美托咪定对术毕瑞芬太尼抑制拔管期间呛咳反应半数有效效应室浓度的影响

Effect of dextrometramidine on 50%effective concentration of remifentanil in inhibition of cough during extubation

目的探究右美托咪定对术毕瑞芬太尼抑制拔管期间呛咳反应半数有效效应室浓度(EC_(50))的影响。方法选取深圳市宝安区福永人民医院2019年6月至2020年12月收治的60例拟在腹腔镜下行卵巢囊肿剥除术的女性患者作为研究对象,按随机数表法分为右美托咪定(D)组和生理盐水(C)组各30例。D组在麻醉诱导前10 min静脉输注负荷量右美托咪定0.5μg/kg(以生理盐水稀释成4μg/mL,10 min完成),术中给予维持剂量右美托咪定0.2μg/(kg·h)至手术结束前10 min。C组以同样方式静脉输注生理盐水。比较两组患者的睁眼时间、自主呼吸恢复时间及拔管时间和拔管期间的呛咳反应情况,并比较两组患者麻醉诱导前、拔管时、拔管后5 min及出恢复室时的平均动脉压(MAP)、心率(HR)、呼吸频率(RR)及脉氧饱和度(SpO_(2));计算两组患者体动反应的EC_(50)及其95%的可信区间。结果D组患者的睁眼时间和拔管时间分别为(9.53±3.29)min、(9.98±2.23)min,明显长于对照组的(6.41±1.53)min、(7.54±1.15)min,差异均有统计学意义(P<0.05),而两组患者的自主呼吸恢复时间比较差异无统计学意义(P>0.05);D组和C组患者的呛咳评分[(1.38±0.05)分vs(2.33±0.16)分]及改良警觉与镇静评分(OAA/S)评分[(3.51±1.38)分vs(2.08±1.01)分]比较,D组明显低于C组,差异具有统计学意义(P<0.05);D组患者的呛咳反应发生率为26.67%,明显低于C组的70.00%,差异具有统计学意义(P<0.05);D组患者麻醉诱导前的MAP、HR及SpO_(2)与C组比较,差异均无统计学意义(P>0.05);D组患者出恢复室时的MAP、HR水平明显低于C组[(86.19±12.44)mmHg vs(97.21±13.52)mmHg、(67.32±13.44)次/min vs(82.81±10.32)次/min],拔管时的RR水平明显低于C组[(13.46±2.01)次/min vs(10.75±2.98)次/min],差异均有统计学意义(P<0.05);通过Dixon序贯公式计算,D组患者瑞芬太尼抑制拔管时体动反应的EC_(50)为1.7μg/L,95%可信区间为1.5~1.9μg/L,C组瑞芬太尼抑制拔管时体动反应的EC_(50)为2.5μg/L,95%可信区间为2.2~2.7μg/L,差异具有统计学意义(P<0.05)。结论术毕瑞芬太尼抑制拔管期间输注右美托咪定能够有效降低患者体动反应的EC_(50),有效抑制拔管时的呛咳反应,对患者生命体征无明显不良影响,具有较好的临床应用价值。

Objective To investigate the effect of dexmedetomidine on 50%effective concentration(EC_(50))of remifentanil in inhibiting cough during extubation.Methods A total of 60 female patients with laparoscopic ovarian cyst removal,who admitted to Fuyong People’s Hospital of Bao’an District from June 2019 to December 2020,were selected and divided into the dexmedetomidine(D)group and normal saline(C)group according to random number table method,with 30 patients in each group.In group D,the loading dose of dexmedetomidine was 0.5μg/kg(diluted to 4μg/mL with normal saline,10 min before anesthesia induction),and the maintenance dose of dexmedetomidine was 0.2μg/kg/h until 10 min before the end of operation.Group C was infused with normal saline in the same way.The eye opening time,spontaneous breathing recovery time,extubation time and cough reaction during extubation were compared between the two groups.The mean arterial pressure(MAP),heart rate(HR),respiratory rate(RR),and pulse oxygen saturation(SpO_(2))of the two groups before anesthesia induction,extubation,5 minutes after extubation and out of recovery room were compared between the two groups.The EC_(50) and 95%confidence interval of the two groups were calculated.Results The eye opening time and extubation time of group D were(9.53±3.29)min and(9.98±2.23)min,respectively,which were significantly longer than(6.41±1.53)min and(7.54±1.15)min of the group C(P<0.05).There was no significant difference in the recovery time of spontaneous breathing between the two groups(P>0.05).The cough score and Observer’s Assessment of Alertness/Sedation(OAA/S)of group D were(1.38±0.05)points and(3.51±1.38)points vs(2.33±0.16)points and(2.08±1.01)points of and group C(P<0.05);the incidence of cough reaction in group D was26.67%,which was significantly lower than 70.00%in group C(P<0.05).There was no significant difference in MAP,HR and SpO_(2) between group D and group C before anesthesia induction(P>0.05);the levels of MAP and HR levels in group D were(86.19±12.44)mmHg and(67.32±13.44)times/min,respectively,which were significantly lower than corresponding(97.21±13.52)mmHg and(82.81±10.32)times/min in group C,and the RR level at extubation was(13.46±2.01)times/min vs(10.75±2.98)times/min in group C(all P<0.05).According to Dixon sequential formula,the EC_(50) of remifentanil in group D was 1.7μg/L,and the 95%confidence interval was 1.5-1.9μg/L,the EC_(50) of remifentanil in group C was 2.5μg/L and 2.2-2.7μg/L,and the difference was statistically significant(P<0.05).Conclusion Remifentanil infusion dexmedetomidine during extubation can effectively reduce the half effective effect room concentration of patients with body movement reaction,effectively inhibit the cough response during extubation and has no obvious adverse effect on patients’vital signs,so it has good clinical application value.