国际麻醉学与复苏杂志   2011, Issue (3): 0-0
    
右美托咪啶对神经外科手术后气管拔管时气道和循环的影响
陈红生, 徐兴国, 许忠玲, 曹苏1()
1.南通大学附属医院麻醉科
Influence of dexmedetomidine on extubation-induced airway and circulation responsiveness in neurosurgical postoperative
 全文:
摘要：

【摘要】目的 神经外科手术结束前给予小剂量右美托咪啶，采用随机双盲法观察右美托咪啶对气管拔管期间的气道反应和血压、心率的影响。方法 60例神经外科病人随机分为右美托咪啶组（D组）和生理盐水组（N组），分别在缝皮时给予0.5μg•kg-1 右美托咪啶或同等容量的生理盐水，观察患者苏醒时间，拔管期间的呛咳、躁动、心率、血压变化。结果 D组患者无苏醒时间延长（P>0.05）；拔管期间D组共有7例拔管时出现呛咳,N组共有15例出现呛咳(P<0.05)；拔管后1、3、5、10分钟患者躁动明显少于N组（P<0.05），给药前（T1），给药后第1（T2）、第3（T3）和第5分钟（T4），两组舒张压、收缩压和心率比较无明显差异（P>0.05）；拔管即刻（T5）、拔管后1（T6）、3（T7）、5（T8）、10（T9）分钟时D组舒张压分别为85±13 mmHg、84±9 mmHg、80±5 mmHg、68±10 mmHg、70±7mmHg，N组舒张压分别为100±18 mmHg、97±16 mmHg、95±7 mmHg、90±12 mmHg、86±10 mmHg，两组比较有统计学差异（P<0.05）；T5、T6、T7、T8 、T9时D组收缩压分别为142±8 mmHg、140±6 mmHg、135±7 mmHg、122±12 mmHg、125±16 mmHg，N组收缩压分别为155±25 mmHg、153±21 mmHg、145±15 mmHg、137±16 mmHg、138±20 mmHg，两组比较有统计学差异（P<0.05）；T5、T6、T7、T8 、T9时D组心率分别为75±10次/分、73±9次/分、72±7次/分、70±5次/分、68±5 次/分，N组心率分别为100±18次/分、95±15次/分、90±12次/分、86±10次/分、83±11次/分，两组比较有统计学差异（P<0.05）。结论 手术结束前输入0.5μg•kg-1 右美托咪啶，可以减轻神经外科拔管期间的气道反应及维持循环稳定。
关键词： 神经外科;气管拔管；右美托咪啶
Abstract:

Objective Given the 0.5μg • kg-1 dexmedetomidine before the end of neurosurgery, observing the impact of dexmedetomidine on airway responsiveness, blood pressure and heart rate during extubation. Method Sixties cases of neurosurgical patients were randomly divided into the dexmedetomidine group (D group) and saline group (N group), given 0.5μg • kg-1 dexmedetomidine or equal volume saline respectively while suturing skin, observed recovery time, bucking, restlessness, changes of heart rate and blood pressure during extubation, Results Compared with N group, there was no recovery time extended in D group(P>0.05), D group during extubation extubation in 7 cases when coughing, N group of 15 patients had cough (P <0.05); 1,3,5 and 10 minutes after extubation was significantly less than the N group were agitation (P < 0.05), before administration (T1), after administration of 1 (T2), section 3 (T3) and 5 min (T4), two diastolic blood pressure, systolic blood pressure and heart rate showed no significant difference (P> 0.05) ; tracheal extubation (T5), after extubation 1 (T6), 3 (T7), 5 (T8) and 10 (T9) min D group diastolic blood pressure was 85 ± 13 mmHg, 84 ± 9 mmHg, 80 ± 5 mmHg, 68 ± 10 mmHg, 70 ± 7mmHg, N group diastolic blood pressure were 100 ± 18 mmHg, 97 ± 16 mmHg, 95 ± 7 mmHg, 90 ± 12 mmHg and 86 ± 10 mmHg, a significant difference between the two groups (P <0.05); T5, T6, T7, T8 and T9, respectively, when the D group systolic blood pressure was 142 ± 8 mmHg, 140 ± 6 mmHg, 135 ± 7 mmHg, 122 ± 12 mmHg and 125 ± 16 mmHg, N group contraction pressure was 155 ± 25 mmHg, 153 ± 21 mmHg, 145 ± 15 mmHg, 137 ± 16 mmHg and138 ± 20 mmHg, a significant difference between the two groups (P <0.05); T5, T6, T7, T8, and T9 heart rate when the D group were 75 ± 10 beats / min, 73 ± 9 beats / min, 72 ± 7 beats / min, 70 ± 5 beats / min and 68 ± 5 beats / min, N group heart rate was 100 ± 18 times / min, 95 ± 15 beats / min, 90 ± 12 beats / min, 86 ± 10 beats / min and 83 ± 11 beats / min, the two groups was statistically different (P <0.05).Conclusion Giving 0.5μg • kg-1 dexmedetomidine before the end of neurosurgery can reduce airway responsiveness and maintain cycle stability during extubation.
Key words: Neurosurgery; Tracheal extubation; Dexmedetomidine