右美托咪啶对腹腔镜胆囊切除术患者七氟烷麻醉复苏期躁动的影响  

The effect of dexmedetomidine on emergence agitation in patients undergoing laparoscopic cholecystectomy with sevoflurane

作　　者：余洁[1] 邵雪泉[1] 郑丽花[1] 江秀清[1] 

机构地区：[1]浙江省衢州市人民医院麻醉科,浙江衢州324000

出　　处：《中国内镜杂志》2015年第2期159-162,共4页China Journal of Endoscopy

摘　　要：目的观察右美托咪定对腹腔镜胆囊切除术(LC)患者七氟烷麻醉复苏期躁动的影响。方法全身麻醉下行择期LC术90例,年龄20~78岁,ASA分级Ⅰ、Ⅱ级。采用随机数字表法,将其随机分为3组(n=30):七氟烷组(S组)、七氟烷+舒芬太尼组(SS组)和七氟烷+右美托咪定组(SD组)。3组患者术中维持七氟烷呼气末浓度1.3 MAC^1.5 MAC,3组患者缝合皮肤时停止吸入七氟烷,SS组缝合皮肤时手术结束前10 min静脉缓慢注射舒芬太尼0.15μg/kg,SD组手术开始气腹时静脉输注右美托咪定0.5μg/kg,输注时间为10min。S组为空白对照组。观察并记录3组患者手术结束前5 min(T0)、全身麻醉苏醒拔管前(T1)、拔管后即刻(T2)和拔管后5 min(T3)的SBP、HR、SPO2及躁动评分和视觉模拟评分(VAS)。结果与S组和SS组比较,SD组全身麻醉苏醒期SBP、HR明显降低,但与T0时段比较无明显差异或降低,而S组和SS组在T1、T2、T3时段SBP、HR均明显升高;与S组比较,SS组和SD组苏醒期躁动分级评分和躁动发生率明显降低(P<0.05或P<0.01),疼痛评分VAS临床评定优良率显著优于S组(P<0.01);但VAS评分SD组均明显优于SS组(P<0.05)。结论右美托咪定可有效减轻七氟烷麻醉复苏期躁动和心血管应激反应,有利于血流动力学稳定,并可提高LC术后患者苏醒期舒适度。【Objective】To observe the effect of dexmemetomidine on emergence agitation in patients undergoing laparoscopic cholecystectomy with sevoflurane. 【Methods】90 cases of elective cholecystectomy were included,with the age range from 20 to 78 years old and the ASA grading from I to II. The patients were randomly divided into sevoflurane group（Group S）, sevoflurane＋sufentanil group（Group SS） and sevoflurane＋dexmedetomidine group（Group SD） according to the random number table. The end-expiration concentration of sevoflurane was maintained from 1.3 MAC to 1.5 MAC for all cases and stopped at the point of skin closure. Sufentanil was administered intravenously at 0.15μg/kg 10 minutes before the operation was finished in Group SS. Dexmedetomidine was administered at 0.5μg/kg intravenously for 10 minutes at the point of the establishment of pneumoperitoneum. Group S was set as the blank control cohort. SBP,HR,SPO2,sedation-agitation scale and VAS were observed and recorded at the time of T0（before the end of surgery）,T1（wake from anesthesia before extubation）, T2（extubation at once）, T3（5minutes after extubation） among the 3 groups.【Results】SBP and HR decreased distinctly during resuscitation after general anesthesia in Group SD compared with Group S and Group SS. The difference is more outstanding during T1, T2 and T3. Compared with Group S, patients in Group SS and Group SD had a significantly lower incidence of emergence agitation（P〈0.05）, agitation scaling（P〈0.01） and a remarkable advantage on VAS scoring（P〈0.01）,which possessed the superiority in Group SD over Group SS simultaneously（P〈0.05）.【Conclusion】Dexmedetomidine effectively relieves the emergence agitation and cardiovascular stress response which benefits the stability of blood in patients undergoing laparoscopic cholecystectomy with sevoflurane.

关 键 词：右美托咪定 腹腔镜 手术后 麻醉恢复期 躁动 七氟烷 

分 类 号：R657.4[医药卫生—外科学] R614.2[医药卫生—临床医学]