右旋美托咪定对脊柱侧弯矫形术患者术中唤醒的影响  

Effects of dexmedetomidine on wake-up tests of patients undergoing scoliosis surgery

作　　者：胡丽君[1] 李勇[1] 顾小萍[1] 马正良[1] 

机构地区：[1]南京大学医学院附属鼓楼医院麻醉科,210008

出　　处：《国际麻醉学与复苏杂志》2013年第4期304-307,共4页International Journal of Anesthesiology and Resuscitation

基　　金：项目基金：南京市卫生局重点课题（zkx08028）

摘　　要：目的探讨右旋美托咪定（dexmedetomidine，Dex）对脊柱侧弯矫形术患者术中唤醒的影响。方法40例择期全麻下行脊柱侧弯矫形手术患者，美国麻醉医师协会（ASA）分级Ⅰ或Ⅱ级。采用完全随机分组法均分为Dex组（D组）和对照组（C组）（每组20例）。D组麻醉诱导前10min给予0．8μg／kgDex，C组给予同等剂量的生理盐水，分别在10min内静脉泵入，随后行常规诱导插管。术中D组使用维持剂量Dex0．2μg·kg^-1·h^-1至术毕。唤醒试验开始时两组停用麻醉维持药物（D组Dex不停用），从停用所有麻醉药物（Dex除外）到患者活动脚趾的时间定为唤醒时间，唤醒后维持药物继续使用至术毕。记录唤醒试验开始时、唤醒时患者脑电双频指数（bispectralindex，BIS）值、心率（heartrate，HR）、平均动脉压mean arterial pressure，MAP）指标，记录唤醒时间、唤醒质量评分及唤醒期间出血量。结果两组唤醒时间差异无统计学意义；唤醒试验开始时两组患者的MAP、HR比较差异无统计学意义；唤醒时D组患者MAP和HR分别为（79：±6）mmHg（1mmHg=0．133kPa）和（80±9）0次／min，低于对照组MAP（88±6）mmHg和HR（98±7）73次／min（P〈0．05）；D组患者的唤醒质量要明显高于C组（P〈0．01）；D组患者在唤醒期间的出血量为（269±34）ml，小于C组同时期出血量（328±50）ml（P〈0．05）。结论Dex能明显提高脊柱侧弯矫形手术术中唤醒质量，不延长唤醒时间；并且能维持唤醒期间血流动力学稳定，减少唤醒期间出血量。Objective To investigated the effect of dexmedetomidine（Dex） on wake-up tests of patients undergoing scoliosis surgery. Methods Forty patients, aged 12 y-20 y, ASA Ⅰ-Ⅱ, undergoing elective scoliosis surgery were randomly divided into 2 groups： Dex group （group D, n=20）and control group （group C, n=20）. Group D received loading dose of Dex 0.8 μg/kg within 10 min before induction followed by 0.2 μg·kg^-1·h^-1 throughout the surgery. Group C received equal volume of normal saline intravenously. The maintenance drugs were withdrawed at the beginning of wake-up tests. Wake-up time was recorded. BIS values and hemodynamic index, such as HR, MAP, were recorded at the time points of withdrawal and awakening. At the same time, the wake- up time and wake-up quality score, the amount of bleeding during the wake -up tests were also recorded. Results There was no significant difference in wake-up time between two groups. MAP, HR of patients in group D decreased significantly than that in control group（P〈0.05） during wake-up. The wake-up quality of group D was better than that in control group（P〈0.01 ）. Conclusions Dex can increase the wake -up quality of scoliosis surgery significantly without prolonged wake-up time, meanwhile it keeps hemodynamic stable.

关 键 词：右旋美托咪定 脊柱侧弯矫形手术 术中唤醒 

分 类 号：R614[医药卫生—麻醉学]