右美托咪定预防拔管期心血管反应的临床研究  

Dexmedetomidine for prevention of cardiovascular responses during tracheal extubation

作　　者：吴涯雯[1] 黄鸿晖[1] 郭苇航[1] 曾静贤[2] 雷学恒[1] 陈友权[3] 

机构地区：[1]广州医科大学附属第三医院麻醉科,510150 [2]中山大学孙逸仙纪念医院,广州市510120 [3]广州医科大学附属第三医院心内科,510150

出　　处：《实用医学杂志》2013年第15期2426-2428,共3页The Journal of Practical Medicine

基　　金：2010年广东省科技计划项目(编号:201094);2011年广州市科信局科研立项课题(编号:2004KP304);2013年广州市教育局教育科学规划课题(编号:12A082)

摘　　要：目的:探讨右美托咪定在预防拔管期心血管反应的相对最佳剂量及其有效性和安全性。方法:80例择期行腹腔镜手术的患者随机分为A、B、C和D组(均n=20),A、B、C组分别于手术结束前30 min给予0.3、0.6、1.0μg/kg右美托咪定,D组拔管前给予等容量生理盐水。观察患者麻醉前(T1)、拔管时(T2)和拔管后1 min(T3)、3 min(T4)、5 min(T5)时的血流动力学变化,比较清醒时间、自主呼吸恢复时间及拔管后不良反应。结果:各组在T2、T3时段的SBP、DBP及HR显著高于T1时段(P<0.05),A、B、C组显著低于D组,且B组和C组显著低于A组(P<0.05)。各组患者的自主呼吸恢复时间、清醒时间比较,差异无统计学意义(P>0.05)。A、B组恶心呕吐、呛咳不良反应发生率均显著低于C组,差异有统计学意义(P<0.05),而A组和B组之间差异无统计学意义(P>0.05)。结论:0.6μg/kg右美托咪定应用于预防拔管期心血管反应的效果相对最佳,且不延长苏醒时间,不良反应少。Objective To explore the relevant optimal dosage of dexmedetomidine and its efficacy and safety in the prevention of cardiovascular responses during tracheal extubation. Methods A total of 80 patients scheduled for laparoscopic surgery were randomized into groups A, B, C, and D, 20 for each group. Groups A, B, and C received continuous infusions of dexmedetomidine at a dose of 0.3, 0.6, or 1.0 μg/kg, respectively; while group D received an equal volume of saline before tracheal extubation. The changes of systolic blood pressure （SBP）, diastolic blood pressure （DBP） and heart rate （HR） were recorded before induction of anesthesia （T1）, at the time of extnbation （T2）, and at 1 min （T3）, 3 rain （T4）, and 5 rain （TS） after extubation. The time of awakening and adverse reactions after extubation were recorded. Results In each group, SBP, DBP and HR at T2 and T3 were significantly higher than those at T1 （P 〈 0.05）. SBP, DBP and HR were significantly lower in groups A, B, and C than in group D （P 〈 0.05）, and significantly lower in groups B and C than in group A（P 〈 0.05）. Time of recovery of spontaneous breath and awakening did not differ significantly among the four groups （P 〉 0.05）. The rates of nausea and vomiting were significantly lower in groups A and B than in group C （P 〈 0.05）, but did not differ significantly between the groups A and B （P 〉 0.05）. Conclusions Dexmedetomidine at a dose of 0.6 μg/kg has a best effect in the prevention of cardiovascular responses during tracheal extubation and it does not prolong time to awakening and has fewer adverse reactions.

关 键 词：右美托咪啶 气管拔管 心血管反应 剂量 

分 类 号：R614[医药卫生—麻醉学]