鼻内或静脉给予右美托咪定抑制全身麻醉苏醒拔管期不良反应的比较  

The comparison of intranasal and intravenous dexmedetomidine on the adverse reactions of tracheal extubation during wake up of general anesthesia

作　　者：裘学[1] 张兆平[1] 房宁宁[2] 李筱[1] 张建余[1] 顾美蓉[1] 

机构地区：[1]南京医科大学附属无锡市人民医院麻醉科,江苏无锡214023 [2]南京医科大学附属无锡市人民医院体检中心,江苏无锡214023

出　　处：《中国医师进修杂志》2014年第12期27-30,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 观察比较鼻内或静脉给予右美托咪定（Dex）对全身麻醉苏醒拔管期不良反应的影响.方法 将120例ASA分级Ⅰ～Ⅱ级择期全身麻醉腹部手术患者按随机数字表法分为四组（每组30例）,术毕前10 min静脉组单次静脉给予Dex 0.5μg/kg（0.9％氯化钠稀释至10ml,缓慢静注,≥30 s）、鼻内1组鼻内滴入Dex 0.5μg/kg,鼻内2组鼻内滴入Dex 0.8μg/kg,对照组静脉给予相同容量的0.9％氯化钠.观察和记录四组不同时间点的收缩压、平均动脉压（MAP）、心率,记录睁眼时间、拔管时间和拔管期咳嗽发生率及咳嗽严重程度等.结果 静脉组、鼻内1组拔管时收缩压、MAP、心率均明显高于基础状态,差异有统计学意义（P＜0.05）;鼻内2组各时间点收缩压、MAP、心率比较差异无统计学意义（P＞0.05）.对照组拔管前1 min至拔管后5 min收缩压、MAP、心率均明显高于基础状态,拔管时至拔管后3 min明显高于同期静脉组、鼻内1组和鼻内2组,差异有统计学意义（P＜0.05）.四组睁眼时间、拔管时间比较差异无统计学意义（P＞0.05）.静脉组、鼻内1组和鼻内2组拔管前咳嗽和躁动发生率、拔管时咳嗽程度评分3分率均明显低于对照组[43％（13/30）,50％（15/30）,47％ （14/30）比70％ （21/30）; 17％ （5/30）,23％ （7/30）,20％ （6/30）比43％ （13/30）; 53％（16/30）,60％（18/30）,50％（15/30）比80％（24/30）],差异有统计学意义（P＜0.05）.结论 无论鼻内或静脉给予Dex均可有效预防苏醒拔管期应激反应;降低术后躁动、咳嗽发生率和严重程度;鼻内滴入Dex 0.8 μg/kg更安全.Objective To compare the adverse reactions of intranasal and intravenous dexmedetomidine on tracheal extubation during wake up of general anesthesia. Methods One hundred and twenty patients who ASA I or II grade were divided into four groups （each 30 patients） by random digits table method. The patients in intravenous group were given 0.5 ug/kg intravenous dexmedetomidine （diluted to 10 ml by 0.9% sodium chloride, intravenous injection slowly, ≥30 s）. The patients in intranasal group 1 were given 0.5 u g/kg intranasal dexmedetomidine. The patients in intranasal group 2 were given 0.8 u g/kg intranasal dexmedetomidine. The patients in control group were given intravenous 0.9% sodium chloride. The systolic blood pressure（SBP）, mean arterial blood pressure （MAP）, heart rate were compared among groups. Eyes open time and extubation time, the rate of cough and the degree during extubation were compared too. Results The SBP, MAP, heart rate in intravenous group, intranasal group 1 were significantly higher than those in basal state （P 〈 0.05）. The SBP, MAP, heart rate at different time in intranasal group 2 had no significant difference （P〉 0.05 ）. The SBP, MAP, heart rate before extubation and after extubation for 3 min in control group were significantly higher than those in intravenous group, intranasal group 1 and intranasal group 2 （P 〈 0.05 ）. Eyes open time and extubation time among four groups had no significant difference （P 〉 0.05）. The rate of cough, restlessness and 3 scores of degree before extubation in intravenous group, intranasal group 1 and intranasal group 2 were significantly lower than those in control group [ 43% （13/30）, 50%（15/30）,47%（14/30） vs. 70%（21/30）;17%（5/30）,23%（7130）,20%（6/30） vs. 43%（13/30） ;53% （16/30）, 60% （18/30）, 50% （15/30） vs. 80% （24/30） ] （P 〈 0.05 ）. Conclusions Either intravenous or intranasal dexmedetomidine can effectively prevent the stress reaction during extubation, decrease t

关 键 词：气管内拔管 右美托咪定 苏醒 咳嗽 心血管反应 

分 类 号：R614[医药卫生—麻醉学]