预注右美托咪定对无抽搐电休克治疗中应激反应和肌痛的影响
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摘要
目的观察在常规行无抽搐电休克治疗(modified electroconvulsive therapy,MECT)前预注三种剂量右美托咪定对患者应激反应和肌痛的影响。方法选择精神分裂症、抑郁症或躁狂症病程中首次行MECT的患者79例,男38例,女41例,年龄18~65岁,ASAⅠ或Ⅱ级,随机分为四组。分别在常规MECT前静脉匀速泵注右美托咪定0.4μg/kg(D1组,n=20)、0.7μg/kg(D2组,n=19)、1.0μg/kg(D3组,n=20)和等容量生理盐水20 ml(N组,n=20),四组均在10 min内泵完,随即行常规MECT。记录麻醉前(T0)、泵药(右美托咪定或生理盐水)10 min后(T_1)、MECT通电后30 s(T_2)及通电后5 min(T_3)的MAP和HR;记录T0、T_2时血糖和血皮质醇(Cor)浓度;记录通电后30min(T_4)和通电后6 h(T_5)的肌痛视觉模拟评分(VAS),以及苏醒时间和自主呼吸恢复时间。结果与N组比较,T_2时D1、D2、D3组Cor浓度、MAP明显降低,HR明显减慢,D2、D3组血糖浓度明显降低,且降低、减慢幅度D3组大于D2组,D2组大于D1组(P<0.05);T_5时D1、D2、D3组肌痛VAS评分明显下降(P<0.05);D2、D3组苏醒时间明显延长,且下降、延长程度D3组大于D2组,D2组大于D1组(P<0.05)。四组自主呼吸恢复时间差异无统计学意义。结论 MECT治疗前预注右美托咪定,可剂量相关地减轻患者的应激反应和治疗后肌痛,延长苏醒时间。
Objective To observe the effects of three doses of dexmedetomidine hydrochloride on stress and myalgia in patients before conventional modified electroconvulsive therapy( MECT). Methods Seventy-nine patients scheduled for the first time of MECT with schizophrenia,depression or mania patients,38 males and 41 females,aged 18-65 years,ASA physical status Ⅰ or Ⅱ,were randomly divided into four groups. The patients received intravenous drip infusion of dexmedetomidine 0. 4 μg/kg( group D1,n = 20),0. 7 μg/kg( group D2,n = 19),1. 0 μg/kg( group D3,n = 20) and saline 20 ml( group N,n = 20) within 10 min before conventional MECT treatment. The mean arterial pressure( MAP) and heart rate( HR)were recorded before anesthesia( T0),drug pump( dexmedetomidine or saline) after 10 min( T_1),30 s after MECT shock( T_2) and 5 min after MECT shock( T_3); the blood glucose and the concentration of serum cortisol( Cor) were recorded at T0 and T_2; visual analogue scores( VAS) 30 min after electric shock( T_4) and 6 h after shock( T_5),the recovery time,recovery time of spontaneous breathing were also recorded. Results Compared with group N,the concentration of Cor and MAP at T_2 were decreased significantly,the HR was increased significantly in groups D1-D3; the blood glucose at T_2 were decreased significantly in groups D2,D3( P < 0. 05). The degree in group D3 was larger than that in group D2,and the degree in group D2 was larger than that in group D1( P < 0. 05). Compared with group N,the VAS score at T_5 were decreased significantly in groups D1-D3; the recovery time was prolonged significantly in groups D2,D3.The degree in group D3 was larger than that in group D2,and the degree in group D2 was larger than that in group D1( P < 0. 05). The spontaneous breathing recovery time had no difference in three groups. Conclusion Dexmedetomidine pretreatment before modified electroconvulsive therapy can dose-dependently reduce stress response and treatment related myalgia and prolong the recovery time.
Objective To observe the effects of three doses of dexmedetomidine hydrochloride on stress and myalgia in patients before conventional modified electroconvulsive therapy( MECT). Methods Seventy-nine patients scheduled for the first time of MECT with schizophrenia,depression or mania patients,38 males and 41 females,aged 18-65 years,ASA physical status Ⅰ or Ⅱ,were randomly divided into four groups. The patients received intravenous drip infusion of dexmedetomidine 0. 4 μg/kg( group D1,n = 20),0. 7 μg/kg( group D2,n = 19),1. 0 μg/kg( group D3,n = 20) and saline 20 ml( group N,n = 20) within 10 min before conventional MECT treatment. The mean arterial pressure( MAP) and heart rate( HR)were recorded before anesthesia( T0),drug pump( dexmedetomidine or saline) after 10 min( T_1),30 s after MECT shock( T_2) and 5 min after MECT shock( T_3); the blood glucose and the concentration of serum cortisol( Cor) were recorded at T0 and T_2; visual analogue scores( VAS) 30 min after electric shock( T_4) and 6 h after shock( T_5),the recovery time,recovery time of spontaneous breathing were also recorded. Results Compared with group N,the concentration of Cor and MAP at T_2 were decreased significantly,the HR was increased significantly in groups D1-D3; the blood glucose at T_2 were decreased significantly in groups D2,D3( P < 0. 05). The degree in group D3 was larger than that in group D2,and the degree in group D2 was larger than that in group D1( P < 0. 05). Compared with group N,the VAS score at T_5 were decreased significantly in groups D1-D3; the recovery time was prolonged significantly in groups D2,D3.The degree in group D3 was larger than that in group D2,and the degree in group D2 was larger than that in group D1( P < 0. 05). The spontaneous breathing recovery time had no difference in three groups. Conclusion Dexmedetomidine pretreatment before modified electroconvulsive therapy can dose-dependently reduce stress response and treatment related myalgia and prolong the recovery time.
引文
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[8]陈明慧,俞红丽,常涛,等.右美托咪定用于预防腹腔镜胆囊切除术后恶心呕吐的效果.临床麻醉学杂志,2017,33(3):261-263.
[2]袁世荧,姚尚龙.不同麻醉诱导药对血钾浓度变化及肌颤和肌痛的影响.中华麻醉学杂志,2000,20(1):11-13.
[3]胡明权,缪冬梅,刘睿,等.右美托咪定对椎管内麻醉手术患者应激反应的影响.临床麻醉学杂志,2015,31(1):12-14.
[4]Tan JA,Ho KM,et al.Use of dexmedetomidine as a sedative and analgesic agent in critically ill adult patients:a meta-analysis.Intensive Care Med,2010,36(6):926-939.
[5]徐振东,高蕾,李名伟,等.琥珀胆碱导致术后肌痛发生的危险因素.中华麻醉学杂志,2015,35(6):660-662.
[6]Giovannitti JA,Thorns SM,Crawford JJ.Alpha-2 adrenergic receptor agonists:a review of current clinical applications.Anesth Prog,2015,62(1):31-39.
[7]Chu KS,Wang FY,Hsu HT,et al.The effectiveness of dexmedetomidine infusion for sedating oral cancer patients undergoing awake fibreoptic nasal intubation.Eur J Anaesth,2010,27(1):36-40.
[8]陈明慧,俞红丽,常涛,等.右美托咪定用于预防腹腔镜胆囊切除术后恶心呕吐的效果.临床麻醉学杂志,2017,33(3):261-263.