右美托咪啶对依托咪酯-瑞芬太尼全麻后躁动的影响  

Effect of dexmedetomidine on agitation after etomidate-remifentanil general anesthesia

作　　者：王子申[1] 王福军[1] 孔珉珉[1] 孙小珊[1] 李俊[1] 

机构地区：[1]泰山医学院附属医院,泰安271000

出　　处：《中国实用医药》2014年第19期1-3,共3页China Practical Medicine

摘　　要：目的探讨手术结束前右美托咪啶的使用对依托咪酯-瑞芬太尼全麻后患者躁动的影响。方法 100例择期全麻下妇科腹腔镜手术的患者,ASA I^II级,随机分为右美托咪啶组(D组,50例)和对照组(C组,50例),常规麻醉诱导:气管插管后控制呼吸。术中麻醉维持:依托咪酯靶控效应室(Arden Model)浓度为0.3μg/ml,瑞芬太尼0.20~0.4μg/(kg·min)持续输注,维库溴铵维持肌松。手术结束前30 min接静脉镇痛泵。两组患者均于手术结束前10 min停止麻醉药物的输入,用静脉推注泵分别静脉推注生理盐水(C组)和右美托咪啶0.5μg/kg,推注时间均为10 min。比较两组的苏醒、拔管时间、拔管期间患者躁动的情况,观察HR、SBP、DBP、RR的变化。结果镇静和躁动情况与T0比较,C组T2、T4、T5时镇静评分均降低(P<0.05);D组T2、T4~T6时的镇静评分均显著升高(P<0.01),且高于C组(P<0.01)。D组躁动程度评分均显著低于C组(P<0.01)。结论手术结束前静脉给予右美托咪啶0.5μg/kg,能显著减少依托咪酯静脉麻醉后所致的躁动反应,使血流动力学更趋稳定,且不会使患者苏醒期延长。Objective To investigate the effect of dexmedetomidine on agitation after etomidate-remifentanil anesthesiabefore end of surgery.MethodsChose 100 patients who under general anesthesia laparoscopic operation, ASA I^II, randomly divided them into dexmedetomidine group（group D, 50 cases） and control group（group C, 50 cases）, routine anesthesia induction, after tracheal intubation, breath control, maintenance of anesthesia： etomidate target controlled effect compartment （Arden Model） concentration of 0.3μg/ml, remifentanil 0.20~0.4μg/（kg＆#183;min） continuous infusion, vecuronium to maintain muscle relaxation. Operation before the end of 30 min after intravenous analgesia pump. Two groups of patients in operation before the end of the 10min stop drug input, using intravenous injection pump intravenous injection of physiological saline （group C） and dexmedetomidine 0.5μ g/kg, injection time of 10min. Compared with two groups of awakening, extubation time, extubation agitation of patients with HR, to observe the change of situation; SBP, DBP, RR. Analysis of data using SPSS 13 statistical softwar.ResultsSedation and agitation conditions compared with T0 group, Ramsay score decreased at T2, T4, T5 in group C（P＆lt;0.05）; group D, T2, T4~T6 Ramsay score increased significantly （P＆lt;0.01）, and higher than that of group C （P＆lt;0.01）. Group D agitation score was significantly lower than group C （P＆lt;0.01）.ConclusionIntravenous dexmedetomidine 0.5μg/kg before end of surgery can significantly reduce agitation etomidate intravenous anesthesia recovery period, stable hemodynamics without extending extubation time.

关 键 词：右美托咪啶 全麻苏醒期 气管拔管 镇静 躁动 

分 类 号：R614[医药卫生—麻醉学]