不同剂量右美托咪定对七氟烷吸入麻醉苏醒期躁动的影响  

Effect of different dose of dexmedetomidine on emergence agitation in patients undergoing sevoflurane anesthesia

作　　者：鲁会卿[1] 于艳宏 高艺凡[1] 李宏[1] 

机构地区：[1]武警后勤学院附属医院麻醉科,天津市300162

出　　处：《河北医药》2015年第11期1616-1619,共4页Hebei Medical Journal

摘　　要：目的观察不同剂量右美托咪定对七氟烷麻醉苏醒期躁动的影响。方法选择择期行上腹部手术患者90例,ASAⅠ或Ⅱ级,根据右美托咪定的用量随机分成3组,每组30例,D1组(低剂量组):负荷量0.5μg/kg,持续量0.2μg·kg-1·h-1;D2组(高剂量组):负荷量1μg/kg,维持剂量0.4μg·kg-1·h-1;C组(空白对照组)。观察3组患者术中及到达恢复室后血流动力学指标、Riker镇静躁动评分(SAS)及苏醒期躁动的发生率。结果 3组患者Riker镇静-躁动(SAS)评分,在拔管时点,D1组、D2组低于C组,差异有统计学意义(P<0.05),EA发生率比较C组14例(46.7%)、D1组4例(13.3%)、D2组3例(10%),3组间比较差异有统计学意义(P<0.05)。3组患者HR、MAP比较,组内T3、T4、T5时点,C组HR、MAP明显升高,与麻醉前(T0)时点比较,差异有统计学意义(P<0.05或<0.01);而D1组、D2组在T3、T4时间点HR、MAP均表现平稳,与麻醉前比较,差异均无统计学意义(P>0.05),D1组在拔管后T6、T7、T8、T9时点,D2在拔管后T5、T6、T7、T8、T9时点HR、MAP均明显下降,与麻醉前比较差异均有统计学意义(P<0.05或<0.01);组间比较,D1组在T4、T5,D2组在T3、T4、T5、T6、T7时点,HR、MAP明显下降,与C组同一时间点比较,差异有统计学意义(P<0.05或<0.01)。结论右美托咪定能安全有效地降低七氟烷全麻苏醒期躁动的发生,然而高剂量和低剂量DEX预防EA的效果并未表现出剂量依赖性。由此认为临床应用中采用DEX负荷量0.5μg/kg,持续量0.2μg·kg-1·h-1预防EA更为合理。Objective To observe the effect of different dose of dexmedetomidine on emergence agitation（ EA） in patients undergoing sevoflurane anesthesia. Methods Ninety patients（ ASA gradeⅠ degree or gradeⅡ） who were scheduled for upper abdominal operation after undergoing general anesthesia with sevoflurance were enrolled in the study. These patients were randomly divided into three groups,with 30 patients in each group. D1 group（ low- dose dexmedetomidine group） ： a load of 0. 5μg / kg followed by a maintenance infusion of 0. 2μg / kg / h; D2 group（ high- dose dexmedetomidine group） ： a load of 1μg / kg followed by a maintenance infusion of 0. 4μg / kg / h; group C（ blank control group） ： the equal volume of normal saline was infused in group C. The hemodynamic parameters during operation and convalescence,Riker sedation-agitation score（ SAS） and the incidence of EA were observed for the three groups. Results In the time point of extubation,the Riker SAS in D1 group and D2 group was significantly lower than that in group C（ P〈 0. 05）. The incidence of EA in group C was46. 7%（ 14 cases）,13. 3%（ 4 cases） in D1 group,10%（ 3 cases） in D2 group,there were significant differences among the three groups（ P〈 0. 05）. The HR,MAP in group C in the time points of T3,T4,T5,were significantly increased,as compared with those in the time point of T0 before anesthesia（ P〈 0. 05 or 〈0. 01）,however,which in the time points of T3,T4 in D1 group and D2 group were the same as those before anesthesia（ P〉 0. 05）. The HR and MAP in the time points of T6,T7,T8,T9 after extubation in D1 group and T5,T6,T7,T8,T9 in D2 group were significantly decreased,as compared with those before anesthesia（ P〈 0. 05 or〈 0. 01）. The group comparison： HR and MAP in the time points of T4,T5 after extubation in D1 group and T3,T4,T5,T6,T7 in D2 group were significantly decreased,as compared with those at the same time points in group C（ P〈 0. 05 or 〈0. 01）. Conclusion Dexm

关 键 词：右美托咪定 七氟烷 麻醉 全身 苏醒期 躁动 

分 类 号：R614[医药卫生—麻醉学]