摘要
目的 观察两种不同剂量右美托咪定对甲状腺手术全麻患者苏醒期质量的影响.方法 采用前瞻性随机对照双盲研究方法,选择中国医科大学附属盛京医院择期行甲状腺手术患者90例,按随机数字表法分为对照组和右美托咪定0.4μg/kg组、0.8μg/lkg组（D0.4组、D0.8组）3组,每组30例.分别于诱导插管后30 min内静脉泵入相应剂量右美托咪定或等量生理盐水.记录给药前、手术结束时、睁眼即刻、拔管即刻、拔管后10 min的心率（HR）、收缩压（SBP）和舒张压（DBP）;记录术毕至睁眼时间和拔管时间以及术前、术毕时呼气末二氧化碳分压（PETCO2）,评价苏醒躁动程度评分（RS）、镇静评分（Ramsay）和拔管后10 min疼痛视管模糊评分（VAS）,以及拔管期间不良事件,如呛咳、恶心呕吐、呼吸抑制等.结果 ①睁眼即刻、拔管即刻、拔管后10 min时,D0.4组和D0.8组HR、SBP和DBP均明显低于对照组;其中D0.8组拔管即刻、拔管后10 min时HR均低于D0.4组,睁眼即刻、拔管即刻SBP均低于D0.4组,睁眼即刻DBP明显低于D0.4组.②D0.4组和D0.8组RS评分、VAS评分低于对照组,Ramsay评分高于对照组[RS（分）：1.40±0.51、1.20±0.42比1.90±0.56,VAS（分）：1.50±0.52、0.80±0.63比2.50±0.52,Ramsay（分）：2.10±0.56、2.40±0.51比1.60±0.51,P＜0.05或P＜0.01];且D0.8组VAS评分明显低于D0.4组（P＜0.01）.D0.8组术毕至睁眼时间和拔管时间明显长于对照组和D0.4组（min：12.50 ± 1.08比10.50±1.58、10.40±1.26,15.00±0.94比13.00±1.63、12.80±1.13,P＜0.05或P＜0.01）,而对照组与D0.4组之间均无差异.3组患者术前及术毕PETCO2比较差异均无统计学意义.③对照组呛咳反应和恶心呕吐发生率（16.7％、13.3％）均明显高于D0.4组（3.3％、0）和D0.8组（0、0）;3组患者均无呼吸抑制发生.结论 麻醉诱导后30 min泵入0.4μg/kg右美托咪定可使甲状腺手术全麻患者苏醒期HR和血压更平稳,且能缩短苏醒时间和拔管时间.
Objective To investigate effects of two doses of dexmedetomidine （Dex） on the recovery quality from general anesthesia undergoing thyroidectomy.Methods A prospective randomized controlled double-blind trial was conducted in 90 patients admitted to Shengjing Hospital of China Medical University who were scheduled for thyroidectomy.They were randomly divided into three groups：group D0.4 received Dex 0.4 μg/kg intravenously,group D0.8 received Dex 0.8 μg/kg intravenously,and control group with same volume of normal saline.There were 30 patients in each group,and all the patients received the above drug or saline 30 minutes after intubation.The heart rate （HR）,systolic blood pressure （SBP） and diastolic blood pressure （DBP） were recorded before Dex administration,at the end of surgery,time of eye opening and extubation,and 10 minutes after extubation.Time of eye opening after surgery and time of extubation after eye opening were recorded.End-tidal partial pressure of carbon dioxide （PETCO2） before and after operation as well as restlessness score （RS）,Ramsay sedative score,and visual analogue pain scale （VAS） scores at 10 minutes after extubation were recorded.Events during extubation including cough,nausea and vomiting,respiratory depression were also recorded.Results ① Compared with control group,in D0.4 and D0.8 groups incidence of lowering of HR,SBP and DBP was lower at time of eye opening and extubation,and 10 minutes after extubation.Compared with D0.4 group,D0.8 group had lower HR at the time of extubation and 10 minutes after extubation,SBP was lower at the time of eye opening and extubation,and lower DBP at the time of eye opening.② D0.4 and D0.8 groups showed lower RS and VAS scores than those of control group,Ramsay sedative score in groups D0.4 and D0.8 was higher than that in control group （RS：1.40±0.51,1.20±0.42 vs.1.90±0.56; VAS：1.50±0.52,0.80±0.63 vs.2.50 ± 0.52; Ramsay：2.10 ± 0.56,2.40 ± 0.51 vs.1.60 ± 0.51,P＜0.05 or P＜0.01）,and VAS score in group D0.8 was lower than that in D0.4 group （P＜0.01）.The time of eye opening and extubation were longer in group D0.8 as compared with those in control and D0.4 groups （minutes：12.50 ± 1.08 vs.10.50 ± 1.58,10.40 ± 1.26; 15.00 ± 0.94 vs.13.00 ± 1.63,12.80 ± 1.13,P＜0.05 or P＜0.01）,but there was no significant difference between the latter two groups.No significant difference in PETCO2 was found among three groups before and after surgery.③ The incidence rate of cough,nausea and vomiting in control group （16.7％,13.3％） were significantly higher than those in groups D0.4 （3.3％,0） and D0.8 （0,0）.There was no respiratory depression in the three groups.Conclusion Adjunctive infusion of Dex 0.4 μg/kg at 30 minutes after anesthesia induction was recommended as it may result in more steady hemodynamics,with shorter recovery time and extubation time after thyroidectomy.
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2014年第4期239-243,共5页
Chinese Critical Care Medicine
基金
国家自然科学基金（81000824）
