右美托咪定对腹腔镜下全结肠切除患者全麻苏醒期的影响
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摘要
目的:探讨右美托咪定对腹腔镜下全结肠切除术患者麻醉苏醒期的影响。方法:择期全麻下行腹腔镜下全结肠切除术患者60例,年龄30～80岁,ASA分级Ⅰ～Ⅱ级,采用随机数字表法随机分为对照组(C组,n=30)和右美托咪定组(D组,n=30)。两组患者均采用静脉注射咪达唑仑、芬太尼、丙泊酚、顺阿曲库铵行麻醉诱导,术中均以瑞芬太尼、丙泊酚、七氟醚维持麻醉。D组患者插管后泵注右美托咪定负荷剂量1μg/kg,10 min后改为0.5μg/kg维持,C组插管后泵注同体积同速度的生理盐水,两组均在全结肠切下尚未吻合时停止给药。记录两组患者一般情况、插管后即刻(T0)、气腹建立前(T1)、气腹建立后2 min(T2)、拔管前即刻(T3)、拔管后2 min(T4)的平均动脉压(MAP)和心率(HR);同时记录丙泊酚、瑞芬太尼用量,苏醒期带管时间(手术结束至清醒拔管),VAS评分以及术后躁动发生情况。结果:D组苏醒期HR为(71.3±3.0)次/min,MAP为(70.2±3.0)mmHg,苏醒期带管时间为(3.1±1.0)min, VAS评分(3.9±0.5)分,苏醒期躁动发生率17%;而C组苏醒期HR为(87.5±3.0)次/min,MAP为(88.7±4.3)mmHg,苏醒期带管时间为(13.8±2.7)min,VAS评分(7.7±1.0)分,苏醒期躁动发生率50%,D组其它各指标值均明显低于C组(P<0.05)。两组患者丙泊酚、瑞芬太尼用量差异无统计学意义。结论:腹腔镜下全结肠切除患者泵注右美托咪定可提高苏醒质量。
Objective To evaluate the effect of dexmedetomidine on stage of general anesthesia of patients undergoing laparoscopic total colectomy. Methods Sixty patients aged 30–80 years(ASA Ⅰ or Ⅱ) were randomly divided into dexmedetomidine group(group D, n=30) and control group(group C, n=30). The patients in group D were given intravenous infusion of dexmedetomidine(1 μg/kg) for 10 min, then given 0.5 μg/kg during the operation. The patients in group C were treated with the same volume of NS. The extubation time, visual analogue scale(VAS) score, incidence of emergence agitation, hemodynamics, total dose of propofol and remifentanil were analyzed. Results In group D, the HR and MAP of emergence were(71.3±3.0) bpm and(70.2±3.0) mmHg, the extubation time was(3.1±1.0) min, the VAS score was 3.9±0.5, and the incidence of emergence agitation was 17%, which were lower than those in group C. In group C, the HR and MAP of emergence were(87.5±3.0) bpm and(88.7±4.3) mmHg, the extubation time was(13.8±2.7) min, the VAS score was 7.7±1.0, and the incidence of emergence agitation was 50%(P<0.05). There was no significantly difference in the total dose of propofol and remifentanil between two groups. Conclusion Intraoperative intravenous administration of dexmedetomidine can improve the quality of emergence of patients undergoing laparoscopic total colectomy.
Objective To evaluate the effect of dexmedetomidine on stage of general anesthesia of patients undergoing laparoscopic total colectomy. Methods Sixty patients aged 30–80 years(ASA Ⅰ or Ⅱ) were randomly divided into dexmedetomidine group(group D, n=30) and control group(group C, n=30). The patients in group D were given intravenous infusion of dexmedetomidine(1 μg/kg) for 10 min, then given 0.5 μg/kg during the operation. The patients in group C were treated with the same volume of NS. The extubation time, visual analogue scale(VAS) score, incidence of emergence agitation, hemodynamics, total dose of propofol and remifentanil were analyzed. Results In group D, the HR and MAP of emergence were(71.3±3.0) bpm and(70.2±3.0) mmHg, the extubation time was(3.1±1.0) min, the VAS score was 3.9±0.5, and the incidence of emergence agitation was 17%, which were lower than those in group C. In group C, the HR and MAP of emergence were(87.5±3.0) bpm and(88.7±4.3) mmHg, the extubation time was(13.8±2.7) min, the VAS score was 7.7±1.0, and the incidence of emergence agitation was 50%(P<0.05). There was no significantly difference in the total dose of propofol and remifentanil between two groups. Conclusion Intraoperative intravenous administration of dexmedetomidine can improve the quality of emergence of patients undergoing laparoscopic total colectomy.
引文
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[2]Mantz J,Josserand J,Hamada S.Dexmedetomidine:new insights[J].Eur J Anaesthesiol,2011,28(1):3-6.
[3]Ebert TJ,Hall JE,Barney JA,et al.The effects of increasing plasma concentrations of dexmedetomidine in humans[J].Anesthesiology,2000,93(2):382-394.
[4]Belleville JP,Ward DS,Bloor BC,et al.Effects of intravenous dexmedetomidine in humans.I.Sedation,ventilation,and metabolic rate[J].Anesthesiology,1992,77(6):1125-1133.
[5]谢淑华,魏颖,耿立成,等.右美托咪定不同用法在悬雍垂腭咽成形术患者全麻中的应用[J].山东医药,2015(20):69-71.
[6]耿兴强.右美托咪定对非体外循环冠脉搭桥术患者血流动力学及肾功能的影响[D].安徽医科大学麻醉学,2018.
[7]朱雯霏,范素红,王永浩.利多卡因胶浆涂抹导尿管预防患者全身麻醉术后苏醒期躁动的效果[J].中华现代护理杂志,2011,17(22):2621-2622.
[8]赵立新,梁越,王举.腹腔镜全结肠切除术7例临床分析[J].现代中西医结合杂志,2012,21(28):3132-3133.
[9]夏勇军,张蓬勃,雷育华.右美托咪定联合地佐辛对老年患者上腹部手术全麻恢复期的临床效果[J].国际麻醉学与复苏杂志,2014,35(5):414-418.
[10]李发成,王岩,王燕.不同给药速度和方法对舒芬太尼诱导全身麻醉患者苏醒质量的影响比较[J].中华保健医学杂志,2018,20(2):157-158.
[11]杜英杰,杨丽静,王古岩.右美托咪定的神经保护作用[J].中国循环杂志,2013(z1):223-224.
[12]王锦琰.内脏痛[J].中国疼痛医学杂志,2006,12(3):130-131.
[13]Jun GW,Kim MS,Yang HJ,et al.Laparoscopic appendectomy under spinal anesthesia with dexmedetomidine infusion[J].Korean J Anesthesiol,2014,67(4):246-251.
[14]Funai Y,Pickering AE,Uta D,et al.Systemic dexmedetomidine augments inhibitory synaptic transmission in the superficial dorsal horn through activation of descending noradrenergic control:an in vivo patch-clamp analysis of analgesic mechanisms[J].Pain,2014,155(3):617-628.
[15]吴新民,薛张纲,马虹,等.右美托咪定临床应用专家共识(2018)[J].临床麻醉学杂志,2018,34(8):820-823.