持续泵注不同剂量右旋美托咪定缓解食管癌手术患者麻醉苏醒期副作用  

Alleviate side effect of post-anesthesia recovery in patients with esophageal surgery by infusing different doses of dexmedetomidine

作　　者：郝建礼[1] 黄泽清[1] 侴伟平[1] 

机构地区：[1]辽宁省肿瘤医院麻醉科,沈阳110042

出　　处：《国际麻醉学与复苏杂志》2013年第7期584-587,共4页International Journal of Anesthesiology and Resuscitation

摘　　要：目的观察持续泵注不同剂量右旋美托咪定（dexmedetomidine，DEX）对缓解食管癌手术患者麻醉苏醒期副作用的影响。方法60例食管癌手术患者按随机数字表法分为DEXI组（D。组）、DEX2组（D2组）和对照组（c组），每组20例。麻醉诱导前10minD组泵注DEX0．8μg／kg，然后D。组、D2组分别以0．4pg·kg^-1·h^-1和0．2μg·kg^-1·h^-1持续泵注至术毕，同期C组给予等量生理盐水。记录患者人麻醉后苏醒室时（T1）、拔管即时（T2）以及拔管后5min（B）的平均动脉压（mean artery pressure，MAP）、心率（heart rate，HR）和苏醒时间。血压〉180mmH/100mmHg（1mmHg=0．133kPa）给予盐酸乌拉地尔注射液25mg，HR〉110次／min给予盐酸艾司洛尔注射液20mg，同时观察躁动评分和Ramsay评分。结果苏醒时间D1组[（30．3±4．7）min]明显长于D2组和C组（P〈0．05）。D1组T2时MAP[（88±8）mmHg]和HR[（79±5）次／min]以及D2组T2时MAP[（93±8）mmHg]和HR[（81±6）次/min]均显著升高（P〈0．05），T3时MAP和HR回复至人麻醉后苏醒室时水平。c组T2时MAP[（117±12）mmHg]和HR[（107±8）次／min]以及B时MAP[（108±9）mmHg]和HR[（118±11）次／min]也显著高于人麻醉后苏醒室时（P〈0．05）。c组乌拉地尔和艾司洛尔的使用率显著多于D组（P〈0．05），D1组和D2组的躁动评分分别是（1．2±0．8）和（1．4±0．6），显著低于C组（P〈0．05）；D1组和D2组的镇静评分分别是（4．5±1．2）和（4．0±0．7），显著高于C组（P〈0．05）。结论麻醉诱导前10min泵注DEX0．8μg／kg，术中持续泵注0．2μg·kg^-1·h^-1 DEX能缓解食管癌手术患者苏醒期副作用，既不影响苏醒又能很好地抑制术后躁动。Objective To observe alleviation of side effect in post-anesthesia recovery patients with esophageal surgery by continuous infusion of different doses of dexmedetomidine （DEX）. Methods A total of 60 patients with esophageal cancer surgery were randomly divided into three groups, 20 patients in each group. Before induction of anesthesia, 0.8 μg/kg of DEX were pumped into patients of group D, then 0.4μg·kg^-1·h^-1 of DEX were continuously infused till the end of surgery in group D1. 0.2 μg·kg^-1·h^-1 of DEX were continuously infused till the end of surgery in group DE. patients of group C were continuously infused saline as controls. Mean artery pressure （MAP） and heart rate （HR） were recorded once in the recovery room （T1）, extubation time （T2） and five min after extubation（T3）. The recovery time, agitation score and Ramsay score were recorded, the Urapidil injection 25 mg or the esmolol injection 20 mg were given while blood pressure was〉180 mm Hg/100 mm Hg（1 mm Hg=0.133 kPa） or HR was〉110 bpm. Results the recovery time of group D1（30.3±4.7） min was significantly higher than group D2 and group C（P〈0.05）, group D2 and group C had no difference （P〉0.05）. MAP and HR of group D1 and group D2 at extubation were significantly higher than the recovery room. MAP and HR in group C at T2 （117±12） mm Hg, （107±8） bpm and T3 （108±9） mm Hg, （118±11） bpm were significantly increased compared with the recovery room （P〈0.05）. MAP and HR in group D2（88＋8） mm Hg, （79±5） bpm and group D2（93±8） mm Hg, （81 ±6） bpm at T2 were significantly descreased compared with group C. the dosage of urapidil and esmolol in group C were significantly increased compared with group D. agitation score of group C （2.9±0.4） significantly higher than group D1（1.2±0.8） and group D2（1.4±0.6） （P〈0.05）. the sedation score of group C （1.1±0.5 ） significantly lower than group D1（4.5±1.2） and group D2（4.0±0.7）（P〈0.05）.

关 键 词：右旋美托咪定 食管癌手术 全身麻醉苏醒期 副作用 

分 类 号：R614[医药卫生—麻醉学]