不同剂量右美托咪啶对拔管期心血管反应的影响  

Effects of Different Doses of Dexmedetomidine on Cardiovascular Responses to Tracheal Extubation

作　　者：刘丽[1] 苏子敏[2] 唐俊[1] 徐威[1] 

机构地区：[1]复旦大学附属金山医院麻醉科,上海201508 [2]复旦大学附属中山医院麻醉科,上海200032

出　　处：《中国临床医学》2012年第5期529-531,共3页Chinese Journal of Clinical Medicine

摘　　要：目的:观察手术结束前单次静脉输注不同剂量右美托咪啶对全麻苏醒拔管期患者心血管反应的影响,探讨右美托咪啶在拔管期应用的最佳剂量。方法:美国麻醉师协会(American Society of Anesthesiologists,ASA)评分Ⅰ或Ⅱ级择期行腹腔镜胆囊切除术的患者80例,将其随机均分为A、B、C、D4组,每组20例。手术结束前10 min各组分别静脉输注如下药物:A组0.9%氯化钠液10 mL,B组右美托咪啶0.3μg/kg,C组右美托咪啶0.5μg/kg,D组右美托咪啶0.7μg/kg。记录手术前、拔管前1 min、拔管时、拔管后1 min、5 min、10 min、20 min、30 min的平均动脉压(MAP)和心率(HR);观察患者呼吸恢复时间、苏醒时间、拔管时间及围拔管期不良反应发生情况。结果:与手术前比较,拔管前1 min、拔管时、拔管后1 min A组的MAP、HR及B组的MAP均显著升高(P<0.05),而C、D两组MAP、HR变化不明显。拔管后5 min、10 min、20 min、30 min时C、D组MAP和HR与手术前比较显著降低(P>0.05)。D组有4例发生低血压和5例发生心动过缓,显著高于其余3组;D组患者自主呼吸恢复时间、拔管时间及苏醒时间与A、B、C3组比较,显著延长(P>0.05);拔管期间C、D组的呛咳和躁动发生率显著低于A、B两组(P>0.05)。结论:0.5μg/kg右美托咪啶可以有效抑制全麻苏醒拔管期的心血管反应并减轻拔管期躁动、呛咳等不良反应发生,同时不影响全麻拔管及苏醒时间。Objective：To observe the effects of different doses of dexmedetomidine on cardiovascular responses to tracheal extubation in order to find out the ideal dose of dexmedetomidine. Methods： Eighty American Society of Anesthesiologists （ASA） score I to II adult patients scheduled for under general anesthesia were randomly divided into four groups, and each group in- volved 20 patients. At 10 minutes before the end of surgery, patients were administered intravenous infusion of 10 mL 0.9% sodium chloride solution in group A, dexmedetomidine at a dose of 0.3 μg/kg in group B, dexmedetomidine at a dose of 0.5 μg/kg in group C and dexmedetomidine at a dose of 0.7μg/kg in group D. Mean arterial pressure （MAP） and heart rate （HR） were recorded before operation, 1 min before the tracheal extubation, at tracheal extubation and 5 min, 10 min, 20 min and 30 min after tracheal extubation. The duration from the termination of anesthesia to full recovery of spontaneously breathing, eye opening response to instruction and tracheal extubation were recorded. Postoperative complications were also recorded. Results： At 1 min before tracheal extubation, the moment of tracheal extubation and i min after tracheal extubation, MAP and HR in group A and MAP in group B increased significantly compared with the baseline value before operation, but MAP and HR did not increase significantly in group C and group D. At 5 min, 10 min, 20 min and 30 min after tracheal extubation, MAP and HR in group C and group D decreased significantly compared with the baseline value （P〈0.05）. The time of breathing recovery, eye opening, and extubation were longer in group D compared with group A, group B and group C （P〈0.05）. The incidences of postoperative restlessness and cough were significanthy lower in group C and group D than those in group A （P〈 0.05）. The incidences of hypotension and bradycardia were higher in group D than those in the other three groups. Conclusions： Dexmedetomidine 0.5 μg/kg may attenuate cardi

关 键 词：右美托咪啶 拔管 心血管反应 苏醒 不同剂量 

分 类 号：R614[医药卫生—麻醉学]