国际麻醉学与复苏杂志   2013, Issue (7): 2-2
    
持续泵注不同剂量右旋美托咪定缓解食管癌手术患者麻醉苏醒期副作用
郝建礼, 黄泽清, 侴伟平1()
1.辽宁省肿瘤医院麻醉科
Alleviate side effect of post-anesthesia recovery in patients with esophageal surgery by infusing different doses of dexmedetomidine
 全文:
摘要:

目的 观察持续泵注不同剂量右旋美托咪定对缓解食管癌手术患者麻醉苏醒期副作用的影响。方法 60例食管癌手术患者按随机数字表法分为右旋美托咪定1组(D1组)、右美托咪定2组(D2组)、和对照组(C组),每组20例。麻醉诱导前10min D组泵注右旋美托咪定0.8 ug/kg,然后D1组、D2组分别以0.4 ug•kg-1•h-1和0.2ug•kg-1•h-1持续泵注至术毕,同期C组给予等量生理盐水。记录患者入麻醉后苏醒室(T1)时、拔管即时(T2)以及拔管后5分钟(T3)的平均动脉压和心率,苏醒时间。血压>180/100mmHg(1mmHg=0.133kPa)给予盐酸乌拉地尔注射液25mg,心率>110bpm给予盐酸艾司洛尔注射液20mg,同时观察躁动评分和Ramsay评分。结果 苏醒时间D1组30.3±4.7min明显长于D2组和C组(P<0.05)。D1组拔管即时平均动脉压88±8 mmHg和心率79±5bpm以及D2组拔管即时平均动脉压93±8mmHg和心率81±6bpm均显著升高(P<0.05),拔管后5分钟平均动脉压和心率回复至入麻醉后苏醒室时水平。C组拔管即时平均动脉压117±12mmHg和心率107±8bpm以及拔管后5分钟平均动脉压108±9mmHg和心率118±11bpm也显著高于入麻醉后苏醒室时(P<0.05)。C组乌拉地尔和艾司洛尔的使用率显著多于D组(P<0.05),D1和D2组的躁动评分分别是1.2±0.8和1.4±0.6,显著低于C组( P<0.05);D1和D2组的镇静评分分别是4.5±1.2和4.0±0.7显著高于C组(P<0.05)。结论 麻醉诱导前10min泵注右旋美托咪定0.8 ug/kg,术中持续泵注0.2 ug•kg-1•h-1右旋美托咪定能缓解食管癌手术患者苏醒期副作用,既不影响苏醒又能很好的抑制术后躁动。

关键词: 右旋美托咪定 食管癌手术 全身麻醉苏醒期 副作用
Abstract:

Objective: To observe alleviation side effect of post-anesthesia recovery in patients with esophageal surgery by continuous infusion of different doses of dexmedetomidine. Methods: Totally 60 patients with esophageal cancer surgery were randomly divided into dexmedetomidine three groups,20 patients in each group.Before induction of anesthesia, 0.8 ug / kg of dexmedetomidine were pumped into patients of group D, then 0.4 ug•kg-1•h-1 of dexmedetomidine were continued infusion to the end of surgery in group D1 ; 0.2 ug•kg-1•h-1 of dexmedetomidine were continued infusion to the end of surgery in group D2; patients of group C were continued infusion saline as controls. MAP and HR were recorded at just in the recovery room(T0), extubation time(T1) and five minutes after extubation(T2) .The recovery time ,agitation score and Ramsay score were recorded, the Urapidil injection 25mg or the esmolol injection 20mg were given while blood pressure> 180/100mmHg or heart rate> 110bpm. Results: the recovery time of group D1(30.3±4.7min) was significantly higher than group D2 and group C (P <0.05), group D2 and group C were not difference (P > 0.05); MAP and HR of group D1 and group D2 at extubation were significantly higher than the recovery room; MAP and HR in group C at T2 (117±12mmHg , 107±8bpm )and T3(108±9mmHg,118±11bpm) were significantly increased compared with the recovery room (P < 0.05); MAP and HR in group D1(88±8 mmHg,79±5bpm )and group D2(93±8mmHg,81±6bpm) at T2 were significantly descreased compared with group C;the dosage of urapidil and esmolol in group C were significantly increased compared with group D; agitation score of group C(2.9±0.4) significantly higher than group D1(1.2±0.8) and group D2(1.4±0.6) (P <0.05); the sedation score of group C(1.1±0.5) significantly lower than group D1 (4.5±1.2)and group D2(4.0±0.7)(P <0.05). Conclusion: Dexmedetomidine able to alleviat the side effect of patients in post-anesthesia recovery ,0.2 ug•kg-1•h-1of dexmedetomidine will not affect the recovery time and can inhibit postoperative agitation, reduce the adverse effects of the anesthesia recovery period.

Key words: dexmedetomidine;esophageal surgery ;general anesthesia recovery period;side effect