右美托咪定、地佐辛单独或复合用药对开胸术患者苏醒期躁动的影响  

Effects of dexmedetomidine or dezocine alone or combination of the two agents on emergence agitation in patients undergoing thoracic surgery

作　　者：郑勇萍[1] 郭伟[1] 张宗泽[1] 王焱林[1] 彭勉[1] 王成天[1] 

机构地区：[1]武汉大学中南医院麻醉科,430071

出　　处：《中华麻醉学杂志》2013年第6期672-675,共4页Chinese Journal of Anesthesiology

基　　金：湖北省自然科学基金（2011CDB508）

摘　　要：目的评价右美托咪定、地佐辛单独或复合用药对开胸术患者苏醒期躁动的影响。方法择期拟行开胸术患者80例，ASA分级I或Ⅱ级，年龄18～64岁，体重48～75kg，采用随机数字表法，将其分为4组（n=20）：对照组（c组）、右美托咪定组（DEX组）、地佐辛组（DEZ组）和右美托咪定＋地佐辛组（DEX＋DEZ组）。DEX组于麻醉诱导前15min时静脉注射右美托咪定0．5μg／kg，继静脉输注0．4μg·kg^-1·h^-1至关胸开始，DEZ组于关胸开始静脉注射地佐辛0．1mg／kg，DEX＋DEZ组于麻醉诱导前15min时静脉注射右美托咪定0．5μg／kg，继静脉输注0．4μg·kg^-1·h^-1至关胸开始，静脉注射地佐辛0．1mg／kg，C组麻醉诱导前15min开始至关胸开始时给予等容量生理盐水。每组缝皮开始时静脉注射氟比洛芬酯50mg。分别于麻醉诱导前10min（T1）、关胸完毕缝皮前（T2）、拔除气管导管即刻（T3）、拔除气管导管后15min（T4）时抽取肘静脉血样，采用ELISA法测定血浆c-反应蛋白（CRP）、TNF-α和IL-10的浓度，记录患者苏醒期躁动等不良反应的发生情况，采用Ramsay评分评价镇静程度。结果与c组比较，DEX组、DEZ组和DEX＋DEZ组T2-4时血浆CRP、TNF-α浓度降低，IL-10浓度升高，TNF-α／IL．10比值降低，躁动程度及发生率降低，镇静评分升高（P〈0．05）；与DEX组和DEZ组比较，DEX＋DEZ组T2～4时血浆CRP、TNF-α浓度降低，IL-10浓度升高，TNF-α／IL-10比值降低，躁动程度及发生率降低（P〈0．05）。四组患者苏醒期均无低血压、心动过缓、呼吸抑制、恶心呕吐等发生。结论右美托咪定、地佐辛单独或复合用药均可降低开胸术患者苏醒期躁动程度及发生，同时可抑制炎性反应，且二者复合较单独用药效果更佳。Objective To evaluate the effects of dexmedetomidine or dezocine alone or the combination of the two agents on the emergence agitation in patients undergoing thoracic surgery. Methods Eighty ASA I or II patients, aged 18-64 yr, weighing 48-75 kg, scheduled for elective thoracic surgery under general anesthesia, were randomly divided into 4 groups （ n = 20 each） ： control group （group C）, dexmedetomidine group （group DEX）, dezocine group （group DEZ） and dexmedetomidine ＋ dezocine group （group DEX ＋ DEZ）. In group DEX, dexmedetomidine 0.5 μg/kg was injected intravenously at 15 min before induction of anesthesia, followed by con- tinuous infusion of dexmedetomidine at 0.4μg·kg^-1·h^-1 until beginning of chest closure. Dezocine 0,1 mg/kg was injected intravenously after beginning of chest closure in group DEZ. In group DEX ＋ DEZ, dexmedetomidine 0.5 μg/kg was injected intravenously at 15 mln before induction of anesthesia, followed by continuous infusion of dexmedetomidine at 0.4μg·kg^-1·h^-1 until beginning of chest closure and then dezocine 0.1 mg/kg was injected intravenously. While the equal volume of normal saline was given instead in group C. Flurbiprofen axetil 50 mg was injected intravenously at beginning of skin closure in each group. Venous blood samples were collected for determination of plasma C-reactive protein （CRP）, TNF-α and IL-10 levels at 10 rain before induction of anesthesia （%）, before skin closure （T2 ） , immediately after extubation （T3） and 15 min after extubation （T4）. Side effects such as agitation during emergence from anesthesia were recorded. Sedation was assessed using Ramsay score. Results Compared with group C, the levels of plasma CRP and TNF-α at T2-4 and ratio of TNF-α IL-10 were significantly decreased, the levels of IL-10 were increased at T2-4, the degree and incidence of agitation were decreased, and Ramsay score was increased in the other three groups （ P 〈 0.05）. Compared with groups DEX and DEZ, the levels of p

关 键 词：右美托咪啶 镇痛药 阿片类 麻醉恢复期 精神运动性激动 

分 类 号：R614[医药卫生—麻醉学]