不同右美托咪定给药方案对后腹腔镜泌尿外科手术苏醒期躁动的临床研究  

Effect of Different Protocols of Dexmedetomidine on Emergence Agitation after Retroperitoneoscopic Urologic Surgery

作　　者：范倩倩[1] 刘广林[1] 刘明富[1] 陈敏[1] 栾波[1] 谢亚宁[1] 董海龙[1] 路志红[1] 

机构地区：[1]第四军医大学西京医院麻醉科,陕西西安710032

出　　处：《现代生物医学进展》2015年第26期5077-5079,5097,共4页Progress in Modern Biomedicine

基　　金：国家自然科学基金项目(81070966);贝朗麻醉科研基金项目(BBF-2013-009);西京医院助推项目(XJZT10Y17)

摘　　要：目的:本研究旨在比较负荷量和维持量两种右美托咪定给药方案对泌尿外科手术后苏醒期躁动的作用,研究右美托咪定用药的更优化方案。方法:将于气管插管全身麻醉下行腹腔镜泌尿外科手术的患者随机分入两组。负荷量组在麻醉诱导时10 min内泵注右美托咪定1μg/kg。维持量组从麻醉诱导开始至手术结束持续以0.4μg/kg/h的速度输注右美托咪定。采用丙泊酚(1.5-2mg/kg)和芬太尼(2-4μg/kg)进行全麻诱导。麻醉维持采用七氟烷和瑞芬太尼。记录苏醒期最大Ricker镇静-躁动评分和咳嗽的分级。记录从时间零点到对语言指令有反应的时间和苏醒期的缺氧(Sp O2<90%)、喉痉挛等其他并发症的情况。在术后恢复室,记录残余镇静(入ICU时镇静-躁动评分≤3)、疼痛视觉模拟评分(100分数字分级评分法)和恶心呕吐评分。术后24 h用15项问题的恢复质量问卷评估患者。结果:负荷量组苏醒期躁动评分为4(3-7),维持量组为4(3-4),两组间有显著差异(P=0.047)。负荷量组停药至呼之睁眼时间为19.4±8.1 min,S组为16.8±5.6 min,但无统计学差异。其余指标统计学均无差异。结论:与单次负荷量注射相比,维持量泵注方案更有利于减轻后腹腔镜泌尿外科手术后的苏醒期躁动,且不会引起苏醒时间延长。Objective： Emergence agitation is a common complication after general anesthesia. Risk factors include inhaled anesthetics, pain and noxious stimulation. Dexmedetomidine is an agonist of et2 adrenalinergic receptor and is proved to induce sedation and analgesia. Dexmedetomidine has shown its advantage in controlling emergence agitation. Urologic surgeries are with a high morbidity of emergence agitation. Dexmedetomidine may alleviate the agitation but the optimal protocol is still unclear. Methods： Patients scheduled for retroperitoneoscopic urologic surgery under general anesthesia were randomly assigned to two groups, receiving loading dose or persistent infusion of dexmedetomidine respectively. Anesthesia induction was done with propofol（ 1.5-2 mg/kg）and fentanyl（2-4 i^g/kg）. Anesthesia was maintained by sevoflurane and remifentanil. The maximal Kicker＇s sedation-agitation score and grade of cough during emergence was recorded. Time to response to verbal commences and adverse events include hypoxia and laryngeal spasm was recorded as well. Residual sedation, VAS score and PONV score in the PACU were recorded. At 24 h after surgery patients were evaluated with a QoR-15 questionnaire. Results： The Ricker＇s scores were significantly higher in patients received loading dose [4 （3-7）] compared with those received persistent infusion [4 （3-4）, P=0.047]. Time to open eyes was 19.4± 8.1 min after loading dose, which is comparable to that after persistent infusion （16.8±5.6 min）. There was no difference in other measurements between the two groups. Conclusions： Compared with single dose of the loading dose, persistent infusion of dexmedetomidine could better alleviate emergence agitation after retroperitoneoscopic urologic surgery and would not delay the emergence.

关 键 词：右美托咪定 泌尿外科手术 苏醒期躁动 

分 类 号：R699[医药卫生—泌尿科学] R614[医药卫生—外科学]