术前右美托咪定预处理对骨科全麻手术麻醉深度、脑氧代谢及拔管安全性的影响

Effects of Preoperative Dexmedetomidine Pretreatment on Depth of Anesthesia,Cerebral Oxygen Metabolism and Extubation Safety During Orthopedic General Anesthesia

目的:观察术前右美托咪定预处理对骨科全麻手术麻醉深度、脑氧代谢及拔管安全性的影响。方法:选取2020年3月—2022年3月郑州市第二人民医院行骨科手术的84例患者作为研究对象,采用随机数表法将其分为两组,每组各42例。观察组于麻醉诱导前恒速注1μg/kg右美托咪定,对照组恒速注等量生理盐水,比较两组患者麻醉用药情况、拔管时间,不同时点[麻醉诱导前(T0)、拔管前1 min(T1)、拔管时(T2)、拔管后10 min(T3)]的心率(HR)、收缩压(SBP)、舒张压(DBP)、麻醉深度指数(CSI)、脑氧代谢指标[动脉血氧含量(CaO_(2))、静脉血氧含量(CvO_(2))],T2时点警觉/镇静(OAA/S)评分、呛咳程度评分以及不良反应发生情况。结果:观察组患者术中瑞芬太尼、丙泊酚使用量均低于对照组,差异有统计学意义(t=3.942、4.724,P<0.05);观察组T1、T2、T3时点的SBP、HR及T2、T3时点的DBP均低于对照组,差异有统计学意义(t=7.976、9.185、5.073、5.192、6.842、4.163、4.604、3.823,P<0.05);观察组T0、T1、T2时点CSI均低于对照组,差异有统计学意义(t=50.606、3.609、2.407,P<0.05);两组患者观察组T2时点的CaO_(2)、CvO_(2)均低于T1时点,但高于对照组,差异有统计学意义(t=9.252、6.384,P<0.05);T3时点的CaO_(2)、CvO_(2)均高于T2时点,且观察组高于对照组,差异有统计学意义(t=7.514、2.460,P<0.05)。结论:对患者骨科全麻术前预注右美托咪定可减少全麻药物用量,稳定围术期血流动力学,改善脑氧代谢,维持理想的麻醉深度,减轻拔管时应激反应。

Objective:To observe the effects of preoperative dexmedetomidine pretreatment on depth of anesthesia,cerebral oxygen metabolism and extubation safety during orthopedic general anesthesia.Methods:A total of 84 orthopedic surgery patients in the hospital from March 2020 to March 2022 were enrolled and divided into observation group and control group by random number table method,with 42 cases in each group.The observation group was preinjected with 1μg/kg dexmedetomidine before induction of anesthesia,while the control group was preinjected with the same volume of normal saline.Anesthesia use and extubation time,heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),anesthesia depth index(CSI),cerebral oxygen metabolism indexes[arterial oxygen content(CaO_(2)),venous oxygen content(CvO_(2))]at different time points[before induction of anesthesia(T0),1 min before extubation(T1),at extubation(T2),and 10 min after extubation(T3)],observer assessment of sedation(OAA/S)score at T2,cough severity score,and the occurrence of adverse reactions were compared between the two groups.Results:The intraoperative dosage of remifentanil and propofol in the observation group were lower than those in the control group(t=3.942,4.724;P<0.05).SBP and HR at T1,T2 and T3,DBP at T2 and T3 in the observation group were lower than those in the control group(t=7.976,9.185,5.073,5.192,6.842,4.163,4.604,3.823;P<0.05).The CSI at T0,T1 and T2 in the observation group was lower than that in the control group,and the difference was statistically significant(t=50.606,3.609,2.407;P<0.05).CaO_(2) and CvO_(2) in the two groups at T2 were lower than those at T1,but were higher in the observation group than in the control group(t=9.252,6.384;P<0.05).CaO_(2) and CvO_(2) at T3 were higher than those at T2,and the observation group was higher than the control group,with statistically significant difference(t=7.514,2.460;P<0.05).Conclusion:Pre-injection of dexmedetomidine before orthopedic general anesthesia can reduce the dosage of general anesthesia drugs,stabilize perioperative hemodynamics,improve cerebral oxygen metabolism,maintain the ideal depth of anesthesia,and reduce stress response during extubation.