咪达唑仑和右美托咪定对肥胖患者减重手术全麻恢复期质量的影响

Effects of midazolam and dexmedetomidine on quality of recovery from general anesthesia in obese patients after bariatric surgery

目的咪达唑仑和右美托咪定对肥胖患者减重手术全麻恢复期质量影响的差异报道较少。文中旨在比较咪达唑仑和右美托咪定对行减重手术的肥胖患者全麻恢复期质量的影响。方法选择2020年4月至2021年3月在南京医科大学第一附属医院62例行全身麻醉下腹腔镜减重手术的肥胖患者。采用随机数字表法将患者随机分为咪达唑仑组(n=31)和右美托咪定组(n=31)。比较两组患者术后自主呼吸恢复时间、唤醒时间、拔管时间,以及术中芬太尼需要量;分析患者入手术室时(T_(0))、拔管后1 min(T_(1))、拔管后10 min(T_(2))和拔管后1 h(T_(3))的Ramsay镇静评分、平均动脉压(MAP)、心率(HR)和脉搏血氧饱和度(SpO_(2));分析患者术后1 h内呼吸抑制、寒颤、恶心呕吐、心动过缓等不良反应的发生率。结果与咪达唑仑组比较,右美托咪定组患者自主呼吸恢复时间、唤醒时间和拔管时间显著缩短(P<0.05),且芬太尼用量显著减少(P<0.05)。T_(1)时间点,咪达唑仑组MAP、心率和SpO_(2)较T_(0)时间点明显升高(P<0.05)。右美托咪定组T 1时间MAP、心率较咪达唑仑组明显降低(P<0.05)。T_(2)时间点,两组SpO_(2)均较T_(0)时间点显著降低(P<0.05),右美托咪定组SpO_(2)较咪达唑仑组明显升高(P<0.05)。右美托咪定组术后1 h内呼吸抑制的发生率(9.68%)明显低于咪达唑仑组(33.33%),差异有统计学意义(P<0.05)。结论右美托咪定较咪达唑仑更有助于肥胖患者在减重手术后尽早且安全地拔管,而且能减少围拔管期的血流动力学波动,提高全麻恢复期质量。

Objective There are few reports on the difference between midazolam and dexmedetomidine in the quality of recovery from general anesthesia in obese patients after bariatric surgery.This study aims to compare the effects of midazolam and dexmedetomidine on the quality of recovery among these patients.Methods Sixty-two obese patients who underwent laparoscopic bariatric surgery under general anesthesia in the First Affiliated Hospital of Nanjing Medical University from April 2020 to March 2021 were selected.Patients were randomly divided into midazolam group(n=31)and dexmedetomidine group(n=31)using a random number table method.Postoperative spontaneous breathing recovery time,wake time,extubation time and intraoperative fentanyl requirement were compared between the two groups.The Ramsay sedation score,mean arterial pressure(MAP),heart rate(HR)and pulse oxygen saturation(SpO_(2))were analyzed when the patients entered the operating room(T_(0)),1 min after extubation(T_(1)),10 min after extubation(T_(2))and 1 hour after extubation(T_(3)).The incidence of respiratory depression,chills,nausea and vomiting,bradycardia and other adverse reactions within 1 hour after operation were analyzed.Results Compared with midazolam group,the spontaneous breathing recovery time,wake time and extubation time of patients in dexmedetomidine group were significantly shortened(P<0.05),and the dosage of fentanyl was significantly decreased(P<0.05).At T_(1),MAP,heart rate and SpO_(2) in midazolam group were significantly higher than those at T_(0)(P<0.05).In the dexmedetomidine group,MAP and heart rate were decreased compared with midazolam group(P<0.05).At T_(2),SpO_(2) in both groups was significantly decreased compared with T_(0)(P<0.05),and SpO_(2) in dexmedetomidine group was significantly increased compared with midazolam group(P<0.05).The incidence of respiratory depression within 1 h after operation in dexmedetomidine group(9.68%)was significantly lower than that in midazolam group(33.33%),and the difference was statistically significant(P<0.05).Conclusion Compared with midazolam,dexmedetomidine is more helpful for early and safe extubation in obese patients after bariatric surgery,and can reduce the hemodynamic fluctuation during periextubation and improve the quality of recovery from general anesthesia.