摘要
目的探讨右美托嘧啶对颅脑手术患者术后气管拔管反应和苏醒质量的影响。方法将美国麻醉医师学会分级Ⅰ～Ⅱ级颅脑手术患者60例随机分为3组:D1组[于气管插管后持续泵注右美托嘧啶(1μg/kg/h)至手术结束前1 h停药],D2组[于气管插管拔管前10 min输注右美托嘧啶(1μg/kg)]和C组(静脉输注生理盐水)。三组患者应用丙泊酚(5～10 mg/kg/h)、瑞芬太尼(10～20μg/kg/h)和顺式阿曲序铵(0.1～0.2 mg/kg/h)维持有效麻醉深度。观察并记录平均动脉压(MAP)和心率变化以及术中使用的麻醉药物总量、术后苏醒时间、拔管时间、拔管质量评分、躁动评分和术后24 h咽喉疼痛发生率。结果D1、D2组拔管期间MAP和心率明显低于C组(P<0.05);D1组和D2组拔管质量评分、躁动评分以及术后24 h咽喉疼痛发生率显著低于C组(P<0.05);D1组苏醒时间和拔管时间显著短于D2组和C组(P<0.05);D1组镇静和镇痛药物总量显著少于D2组和C组(P<0.05)。结论右美托嘧啶可以有效预防和减少颅脑手术患者围拔管期心血管反应和呛咳、躁动的发生程度,降低术后24 h咽喉疼痛发生率;麻醉诱导后持续泵注右美托嘧啶不影响苏醒质量,且可以减少麻醉药物用量。
Objective To explore the effect of dexmedetomidine on stress response to tracheal extubation in neurosurgical patients. Methods Sixty patients of ASA class I - II who received neurosurgery were randomly divided into three groups （20 patients in each group）, i.e., group A, group B and control group. The patients in group A received dexmedetomidine （used by intravenous infusion pump, with a velocity of 1 μg/kg/h） after induction of anesthesia until one hour before the end of the operation. The patients in group B received dexmedetomidine （used by intravenous injection, 1μg/kg） 10 minutes before extubation. The patients in control group received equivalent volume of physiological saline. All patients received propofol （5-10 mg/kg/h）, remifentanil （10-20μg/kg/h） and cis-atracurium （0.1-0.2 mg/kg/h） to maintain reasonable level of anesthesia during the operation. The mean arterial pressure （MAP） and heart rate （HR） were recorded before extubation, at the time of extubation, 1 minute and 15 minutes after extubation. The extubation quality scores （reflected in the prevalence of cough after extubation）, postoperative sedation scores, extubation and awakening times, incidence of sore throat within 24 hours after operation and total dosage of narcotic drugs were also recorded and evaluated. Results The MAP and HR significantly increased at the time of extubation compared with before extubation in three groups （P〈0.05）, and then significantly decreased （P〈0.05）. At the time of extubation, 1 minute and 15 minutes after extubation, the MAP and HR were significantly lower in group A and group B than control group （P〈0.05）, and there were no significant difference between group A and group B （P〉0.05）. The extubation quality scores, postoperative sedation scores, extubation and awakening times, incidence of sore throat within 24 hours after operation were significantly lower group A and group B than control group （P〈0.05）, and there were no significant difference between group A and group B （P〉0.05）. The total amount of sedative and analgesic drugs in group A were significantly less than group B （P〈0.05）. Conclusions Dexmedetomidine can attenuate the stress response to tracheal extubation in neurosurgical patients. Continuous infusion of dexmedetomidine after induction of anesthesia can reduce the dosage of narcotic drugs.
出处
《中国临床神经外科杂志》
2013年第12期717-719,722,共4页
Chinese Journal of Clinical Neurosurgery
