上海口腔医学

上海口腔医学 ›› 2016, Vol. 25 ›› Issue (3): 368-372.

• 论著 • 上一篇    下一篇

不同剂量右美托咪定对腮腺手术患者全麻苏醒质量的影响

刘华, 周驰, 纪均   

  1. 上海交通大学医学院附属第九人民医院 麻醉科,上海 200011
  • 收稿日期:2015-11-10 修回日期:2016-02-04 出版日期:2016-06-25 发布日期:2016-07-22
  • 通讯作者: 纪均, E-mail:lordjun@163.com E-mail:liuhua850429@163.com
  • 作者简介:刘华（1985-）,女,硕士,住院医师

Effects of using different dose of dexmedetomidine during tracheal extubation for patients with parotidectomy after general anesthesia

LIU Hua, ZHOU Chi, JI Jun   

  1. Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China
  • Received:2015-11-10 Revised:2016-02-04 Online:2016-06-25 Published:2016-07-22

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摘要： 目的 观察不同剂量右美托咪定对腮腺手术患者全麻苏醒质量的影响。方法 80例行腮腺切除术患者随机分为4组,分别为低、中、高剂量右美托咪定组（D1、D2、D3组）及对照组（C组）,每组20例。各组麻醉诱导及维持相同,手术结束前30 min, D1、D2、D3组分别将右美托咪定0.4、0.8、1.2 μg/kg用生理盐水稀释到20 mL, 10 min内缓慢泵入,C组泵入等量生理盐水。分别于麻醉诱导前(T0)、拔管即刻(T1)、拔管后5 min(T2)、拔管后10 min(T3)记录收缩压、舒张压、心率;PACU期间呛咳、躁动的发生率及程度;拔管即刻的Ramsay镇静评分及数字等级疼痛评分(NRS) ;拔管时间及定向力恢复时间。使用SPSS20.0软件包对数据进行统计学分析。结果 拔管即刻C、D1组血压、心率较拔管前显著升高（P<0.05）,D2、D3组升高不显著(P>0.05)。拔管即刻及拔管后5、10 min,D1组收缩压、舒张压、心率及在PACU的躁动发生情况与C组相近(P>0.05),呛咳的发生率及程度有降低趋势,但无显著差异（P>0.05）;拔管即刻的Ramsay镇静评分及NRS与C组亦无显著差异（P>0.05）。D2、D3组收缩压、舒张压、心率均较同时点C、D1组显著降低,躁动、呛咳发生率及程度显著低于C、D1组(P<0.05),Ramsay镇静评分显著增高（P<0.05）,NRS显著降低（P<0.05）。D3组的Ramsay镇静评分较D2组显著增高（P<0.05）,NRS显著降低（P<0.05）。D3组患者拔管时间、定向力恢复时间较D1、D2、C组显著延长(P<0.05)。结论 腮腺手术结束前泵注右美托咪定可以减少苏醒期间血流动力学波动,提高苏醒质量,中等剂量的右美托咪定（0.8 μg/kg）更安全,不延长拔管和定向力恢复时间。

关键词: 右美托咪定, 全麻苏醒, 腮腺手术

Abstract: PURPOSE: To observe the effects of using different-dose dexmedetomidine during tracheal extubation for patients with parotidectomy after general anesthesia. METHODS: Eighty patients with "ASA I~II"scheduled for parotidectomy under general anesthesia were randomly divided into 4 groups, dexmedetomidine group (D1, D2, D3 group) and control group (C group), 20 cases in each group. Anesthesia induction and maintenance were the same. Thirty minutes before the end of surgery, patients in group D1,D2,D3 and group C were infused dexmedetomidine 0.4, 0.8, 1.2 μg/kg diluted to 20 mL and the same volume of normal saline respectively within 10 minutes. After surgery, all patients were sent to the PACU. Extubation was applied to the patients who had extubation indications. SBP, DBP and HR were recorded at each time-point including T0(before induction), T1（the time when extubation, T2(5 min after extubation) and T3(10 min after extubation).The conditions of patients' bucking and agitation in PACU were also recorded. Other recorded indications included Ramsay scores and NRS at the time of extubation, extubation time and orientation recovery time. Statistical analysis was performed using SPSS20.0 software package. RESULTS: SBP, DBP and HR at the time of extubation in group C, D1 increased significantly compared with those before extubation (P<0.05). SBP, DBP and HR in group D1 had no significant difference at T0, T1, T2 and T3 from those in group C (P>0.05). Ramsay scores and NRS in group D1 had no significant difference from those in group C (P>0.05). The incidence and degree of bucking in group D1 had declining tendency, but the difference was not significant (P>0.05). SBP, DBP and HR in group D2, D3 were significantly lower at each time-point than those in group C, D1 (P<0.05). The incidence and degree of bucking and agitation in group D2, D3 were lower and lighter than those in group C, D1 and Ramsay scores, NRS also had significant difference (P<0.05). Ramsay scores in group D3 were higher than those in group D2, and NRS in group D3 were significantly lower (P<0.05). Extubation time and orientation recovery time of group D3 were significantly longer than those in group D1, D2 and C (P<0.05). CONCLUSIONS: Dexmedetomidine infusion before the end of parotidectomy can reduce hemodynamic fluctuation during the recovery period and improve the recovery quality. Moderate dose of dexmedetomidine (0.8 μg/kg) was more secure, and would not extend the extubation and orientation recovery time.

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