右美托咪定预防脊柱手术患者全麻后寒战的效果:前瞻性、单盲、随机对照临床研究

Effectiveness of dexmedetomidine on preventing shivering after general anesthesia in patients with spinal surgery: a prospective, single-blind, randomized, and controlled clinical experimental study

目的 探讨右美托咪定预防脊柱手术患者全麻后寒战的效果.方法 选择全麻下脊柱手术患者共78例,随机平分为研究组(泵注右美托咪定)和对照组(泵注生理盐水),观察两组患者气管插管后15、30、60 min及拔管前、拔管后的心率和平均动脉压.记录并比较两组Ramsay镇静评分、寒战分级、寒战出现的时间和术后不良反应的发生情况.结果 研究组拔管前、拔管后心率[心率:(72.3±5.2)次/min与(83.2±4.5)次/min,(73.6±4.9)次/min与(88.9±4.9)次/min,P均＜0.05]、平均动脉压(72.7±5.0) mmHg与(90.3 ±7.9) mmHg,(78.5±4.3) mmHg与(95.5±14.9) mmHg;P均＜0.05]显著低于对照组.研究组寒战发生率显著低于对照组(7.7％与30.8％,x2=6.685,P=0.009),入麻醉苏醒室即刻及30、60 min Ramsay镇静评分显著高于对照组[入PACU即刻:(3.1±1.0)分与(2.0±0.4)分;30 min:(2.1±0.4)分与(1.3±0.2)分;60 rmin:(2.0±0.3)分与(1.1±0.3)分,F组間=12.543,P组间 ＜0.001;F组内=9.391,P组内＜0.001;F交互=5.972,P交互=0.023].对照组恶心、呕吐的发生率高于研究组(P =0.003),但研究组口干的发生率高于对照组(P=0.002).结论 术中应用右美托咪定可以显著减少骨科脊柱手术患者全麻寒战发生率,是预防骨科脊柱手术患者全麻后寒战发生较为理想的药物.

Objective To investigate effectiveness of dexmedetomidine on preventing shivering of patients after spinal surgery.Methods A total of 78 cases with spinal surgery under anesthesia were randomly divided into study group(dexmedetomidine treatment) and the control group(saline treatment).Heart rate(HR)and mean arterial pressure were observed and recorded at 15,30,60 min after intubation,before and after extubation.Ramsay sedation score,chills grading,chills occur time and postoperative adverse reactions were recorded.Results In study group,HR were ((72.3 ± 5.2) time/min,(83.2 ± 4.5) time/min),mean arterial pressure were((72.7 ±5.0) mmHg,(90.3 ±7.9) mmHg) at before and after extubation,significant lower than that of control group((73.6 ±4.9) time/min,(88.9 ±4.9) time/min; (78.5 ±4.3) mmHg,(95.5 ± 14.9)mmHg;P＜0.05).The incidence of shivering (7.7％) in study group was significantly lower than the control group(30.8 ％,x2 =6.685,P =0.009).Ramsay sedation score at immediately,30 min,60 min into the PACU were (3.1 ± 1.0),(2.1 ± 0.4),(2.0 ± 0.3) respectively,higher than those of control group ((2.0 ± 0.4),(1.3±0.2),(1.1 ±0.3) ; F inter-group =12.543,P＜0.001;F inner-group =9.391,P ＜0.001;F interaction =5.972,P =0.023).The incidence of adverse reactions such as nausea and vomiting in the control group was higher than those of the study group(P =0.003),while the incidence of dry mouth in study group was higher (P =0.002).Conclusion Intraoperative dexmedetomidine can significantly reduce the incidence and degree of shivering in patients with orthopedic spinal surgery after general anesthesia.Dexmedetomidine is proved to be a more ideal drug to prevent shivering in orthopedic spine surgery after general anesthesia.