不同剂量右美托咪定用于高血压患者全麻恢复期安静拔管的可行性  

Different doses of dexmedetomidine for quiet extubation during anesthesia recovery in hypertensive patients

作　　者：王怡鸾[1] 陈丽琼[1] 吴斌[1] 张旭彤[1] 朱纯纯[1] 李影[1] 朱开来[1] 李军[1] 

机构地区：[1]温州医科大学附属第二医院麻醉科,325027

出　　处：《中华医学杂志》2015年第38期3129-3132,共4页National Medical Journal of China

基　　金：浙江省医学会临床科研基金项目（2012ZYC-A29）

摘　　要：目的 探讨在Narcotrend监测下不同剂量右美托咪定用于高血压患者全麻恢复期安静拔管的可行性.方法 选择2012年8月至2014年6月在温州医科大学附属第二医院择期甲状腺手术的高血压患者120例,随机分成6组,于手术结束前半小时分别给予右美托咪定0.4（M1组）、0.6（M2组）、0.8（M3组）、1.0（M4组）μg·kg-1·h-1,瑞芬太尼0.1 μg· kg-1·min-1（R组）,对照组（S组）常规拔管,每组20例,各组均在Narcotrend指数（NI）值恢复至≥80时拔除气管导管.观察并记录各组患者入室基础值（T0）,手术结束前半小时（T1）及15 min（T2）,停七氟烷（T3）,拔管前（T4）,拔管后1 min（T5）、5 min（T6）及10 min（T7）的心率（HR）、收缩压（SBP）、七氟烷最低肺泡有效浓度（MAC）值,记录各组拔管时间、苏醒时间及相关不良反应.本研究通过温州医科大学附属第二医院伦理委员会批准及患者知情同意.结果 与T0相比,各M组T4～T7SBP、HR明显降低（均P＜0.05）,R组T6、T7 SBP、HR明显降低（均P＜0.05）;R组T6、T7 SBP,T4 ～T7 HR明显低于S组（均P＜0.05）.各M组在T4～T7 SBP、HR均明显低于S组及R组（均P＜0.05）.R组、M2～4组T2、T3的七氟烷MAC值较T1及S组明显减小（均P＜0.05）,M3[（19.1±2.8） min]和M4组[（20.6±4.1）min]苏醒时间较其他各组明显延长（均P＜0.05）.各M组和R组患者拔管期呛咳Ⅰ级＋Ⅱ级的百分率明显高于S组（85％、85％、90％、95％、80％比45％,均P＜0.05）.结论 在Narcotrend监测下右美托咪定可安全用于高血压患者全麻恢复期安静拔管,但较大剂量右美托咪定可延长患者苏醒时间.Objective To explore the feasibility of different doses of dexmedetomidine for quiet extubation during anesthesia recovery in hypertensive patients monitored with Narcotrend.Methods A total of 120 hypertensive patients scheduled for thyroid surgery from August 2012 to June 2014 in the Second Affiliated Hospital of Wenzhou Medical University,were randomly divided into 6 groups （n =20 each）.Dexmedetomidine 0.4 （group M1）,0.6 （group M2）,0.8 （group M3） or 1.0 （group M4） μg · kg-1 · h-1,remifentanil 0.1 μg · kg-1 · min-1（group R） and normal saline （group S） were infused for half an hour before the end of surgery,and extubation was carried out when Narcotrend index （NI） values were ≥ 80 in each group.Data of heart rate （HR）,systolic blood pressure （SBP） and minimal alveolar concentration （MAC） of sevoflurane were observed and recorded at the time of baseline （T0）,half an hour （T1） and 15 min （T2） before the end of surgery,stopping sevoflurane （T3）,before extubation （T4）,1 min （T5）,5 min （T6） and 10 min （T7） after extubation.Extubation time,recovery time and related adverse reactions were also recorded.Results Compared with T0,SBP and HR at T4 to T7 in four M groups were significandy lower （all P 〈 0.05）.SBP and HR at T6,T7 in group R were significantly lower than at T0 （all P 〈 0.05）.SBP at T6,T7 and HR at T4 to T7 in group R were significantly lower than that of group S （all P 〈 0.05）.SBP and HR at T4 to T7 in four M groups were significantly lower than that of group S and group R （all P 〈 0.05）.The values of MAC of sevoflurane at T2 and T3 in group R and M2-4 were significantly lower than at T1 and that of group S （all P 〈 0.05）.Recovery time in group M3 [（19.1 ± 2.8） min] and group M4 [（20.6 ±4.1） min] were significantly longer compared with other four groups （all P 〈 0.05）.The percentage of cough grade at level Ⅰ and lⅡ in each M group and group R during extubation was significantly

关 键 词：右美托咪定 麻醉恢复期 高血压 呛咳 

分 类 号：R614[医药卫生—麻醉学]