右美托咪定联合纳布啡对腹腔镜胆囊切除术患者全身麻醉苏醒期血流动力学和躁动的影响

Effects of dexmedetomidine combined with naborphine on hemodynamics and restlessness during recovery from general anesthesia in patients undergoing laparoscopic cholecystectomy

目的探讨右美托咪定(DEX)联合纳布啡对腹腔镜胆囊切除术(LC)患者全身麻醉苏醒期血流动力学和躁动的影响。方法将2020年12月至2022年7月在六安市中医院行LC治疗的120例患者纳入本次前瞻性研究,采用随机数字表法分为对照组(n=60)和联合组(n=60)。于手术结束前10 min,对照组患者静脉泵注右美托咪定,剂量为0.4μg/kg,联合组患者静脉注射纳布啡,剂量为0.2 mg/kg同时泵注右美托咪定,剂量为0.4μg/kg。比较2组患者如下指标:(1)手术结束时(T0)、拔管前(T1)、拔管即刻(T2)、拔管后5 min(T3)和拔管后10 min(T4)的心率和平均动脉压(MAP);(2)手术时长、苏醒时间和拔管时间;(3)苏醒期Ricker镇静-躁动评分(SAS)、躁动率和呛咳程度。结果2组相同时间点(T0、T1、T2、T3和T4时)的MAP差异无统计学意义(P>0.05);2组在T0、T1和T4时的心率差异无统计学意义(P>0.05),但联合组在T2、T3时的心率分别(70.89±8.98)、(65.32±8.04)次/min,均较对照组[(74.43±8.36)、(69.62±6.77)次/min]明显降低,差异均有统计学意义(P<0.05)。2组的手术时长、苏醒时间和拔管时间差异无统计学意义(P>0.05);联合组的SAS评分为(4.13±0.91)分,较对照组[(4.49±1.02)分]显著降低,联合组的躁动率为16.67%(10/60),较对照组的35.00%(21/60)显著降低,差异均有统计学意义(P<0.05)。联合组的呛咳程度明显轻于对照组,差异有统计学意义(P<0.05)。结论手术结束前10 min,使用右美托咪定联合纳布啡,可有效控制苏醒期血流动力学波动,降低躁动发生率且不影响苏醒时间。

Objective To investigate the effects of dexmedetomidine(DEX)combined with nalbuphine(NAB)on hemodynamics and restlessness during recovery from general anesthesia in patients undergoing laparoscopic cholecystectomy(LC).Methods A total of 120 patients treated with LC in Lu’an Hospital of traditional Chinese Medicine from December 2020 to July 2022 were included in this prospective study,and randomly divided into control group(n=60)and combined group(n=60).Before the end of 10 min,patients in the control group received intravenous infusion of DEX at a dose of 0.4μg/kg,and patients in the combined group received intravenous infusion of DEX at a dose of 0.4μg/kg and intravenous injection of NAB with a dose of 0.2 mg/kg.The following parameters were compared:(1)heart rate and mean arterial pressure(MAP)at the end of operation(T0),before extubation(T1),immediately after extubation(T2),5 min after extubation(T3)and 10min after extubation(T4).(2)operation time,recovery time and extubation time.(3)Riker sedation agitation score(SAS),restlessness rate and cough degree during recovery.Results MAP of the two groups at the same time point(T0,T1,T2,T3 and T4)all had no significant difference(P>0.05).NO statistical significances of heart rate at T0,T1 and T4 were found between the two groups(P>0.05),but the heart rate at T2 and T3 in the combined group was(70.89±8.98),(65.32±8.04)beats/min,respectively,dramatically lower than those of the control group[(74.43±8.36),(69.62±6.77)beats/min],the differences were statistically significant(P<0.05).There was no significant difference between the two groups in the operation time,awakening time and extubation time(P>0.05).The SAS scores of the combined group were(4.13±0.91)points,which were statistically lower than those of the control group[(4.49±1.02)points],the restlessness rate of the combined group was 16.67%(10/60),which was statistically lower than that of the control group(35.00%,21/60),the differences were statistically significant(P<0.05).The degree of cough in the combined group was dramatically lighter than that in the control group,the differences were statistically significant(P<0.05).Conclusion The application of DEX combined with NAB 10 min before the end of operation can effectively control the hemodynamic fluctuation during recovery period,reduce the incidence of restlessness and do not affect the recovery time.