右美托咪定对重症肌无力患者围术期血流动力学及苏醒质量的影响  

Effects of dexmedetomidine on hemodynamic and quality of awakening in the patients with myasthenia gravis undergoing thymectomy

作　　者：王卓强[1] 魏昌伟[1] 马超[1] 

机构地区：[1]解放军第309医院麻醉科,北京市100091

出　　处：《临床麻醉学杂志》2015年第6期543-545,共3页Journal of Clinical Anesthesiology

摘　　要：目的探讨全麻术中静脉泵注右美托咪定对重症肌无力患者围术期血流动力学及苏醒质量的影响。方法选择60例择期行胸腺扩大切除术的重症肌无力患者(Ossermann I^IIb型)随机均分为右美托咪定组(D组)和对照组(C组)。D组患者麻醉诱导前,给予右美托咪定负荷剂量0.5μg/kg,然后静脉泵注0.5μg·kg-1·h-1至手术结束前30min,C组在同一时段静脉泵注同等容量的生理盐水。记录麻醉前(T1)、插管时(T2)、切皮时(T3)、劈胸骨时(T4)及拔管时(T5)的MAP、HR、单位时间内全麻药的用量;记录自主呼吸恢复时间、呼之睁眼时间和意识完全清醒时间及Steward苏醒评分。结果与T1时比较,T2~T5时两组MAP明显升高,HR明显增快(P<0.05);C组全麻药用量明显高于D组(P<0.05);C组自主呼吸恢复时间、呼之睁眼时间、完全清醒时间和拔管时间明显长于D组,Steward苏醒评分明显低于D组(P<0.05)。结论全麻术中静脉泵注右美托咪定能够保证重症肌无力患者围术期血流动力学稳定、减少全麻药用量、缩短拔管时间,改善了患者的苏醒质量。Objective To investigate the effect of intravenous infusion dexmedetomidine on hemodynamic and quality of awakening in the patients with myasthenia gravis undergoing thymectomy.Methods Sixty myasthenia gravis（Ossermann I-IIb）patients undergoing elective extended thymectomy were randomly divided into dexmedetomidine group（group D,n=30）and control group（group C,n=30）.Patients in group D received a loading dose of dexmedetomidine 0.5μg/kg before induction of anesthesia and an intravenous infusion of 0.5μg·kg^-1·h^-1 30 mins before the end of surgery.While patients in group C were given same volume of saline.Changes of MAP and HR during anesthesia（T1）,intubation（T2）,skin incision（T3）,sternum sawing（T4）and extubation（T5）were monitored.The anesthetics used per hour and time taken to be fully awakeas well as Steward awakening score were also recorded.Results Compared with T1,MAP and HR of patients in both groups increased at T2-T5（P〈0.05）.Compared with group C,the doses of anesthetics used per hour was reduced significantly in group D（P〈0.05）and the time taken to be autonomous respiration,open eyes,fully awakens and extubation were decreased,steward awakening score was increased in group D（P〈0.05）.Conclusion Application of dexmedetomidine in general anesthesia could maintain hemodynamic stability,reducethe doses of anesthetics required for maintenance and extubation time,and could improve the quality of awakening in myasthenia gravis patients undergoing thymectomy.

关 键 词：右美托咪定 重症肌无力 血流动力学 苏醒质量 

分 类 号：R614[医药卫生—麻醉学]