不同剂量右美托咪定预防腹腔镜肠癌手术患者全麻后寒战的临床观察  

Effects of different doses of dexmedetomidine on preventing shivering after general anesthsia in patients with laparoscopic colorectal surgery

作　　者：王红珠[1] 朱利君[1] 陈冯琳[1] 

机构地区：[1]浙江省台州医院麻醉科,浙江临海317000

出　　处：《全科医学临床与教育》2015年第6期639-642,共4页Clinical Education of General Practice

摘　　要：目的 观察不同剂量右美托咪定对腹腔镜肠癌手术患者全麻后寒战的预防作用.方法 全麻下行腹腔镜肠癌手术患者160例,ASAⅠ~Ⅱ级,随机分为四组：S组,D0.25组,D0.5组,D0.75组,每组40例. 手术结束前30 min, D0.25组、D0.5组、D0.75组分别给予0.25μg/kg 、0.5μg/kg、0.75μg/kg右美托咪定,S组给予等量0.9%氯化钠注射液,观察记录患者拔管时间,拔管后10 min、30 min、60 min的动脉压（MAP）、心率（HR）、血氧饱和度（SpO2）、中心体温（鼻咽温度体温）,记录寒战分级、寒战发生率及不良反应.结果 四组每个时点的SpO2、体温、MAP比较,差异均无统计学意义（F分别=1.98、2.42、2.32;1.96、1.32、2.11;1.62、1.78、2.21,P均〉0.05）. D0.5组和D0.75 组拔管时间长于S组、D0.25组,差异有统计学意义（q分别=3.68、4.20;3.89、4.12,P均〈0.05）. D0.25组、D0.5组、D0.75 组寒战的发生率较S组明显降低,差异有统计学意义（χ2分别=20.86、22.74、22.74,P均〈0.05） ,D0.5组、D0.75 组与D0.25组寒战的发生率比较,差异均无统计学意义（χ2分别=2.06、2.06,P均〉0.05）.四组心动过缓、恶心呕吐、谵妄躁动发生率比较,差异有统计学意义（χ2分别=10.71、15.68、15.68,P均〈0.05）. 结论 手术结束前30 min静脉注射右美托咪定可降低术后寒战的发生率,适度镇静镇痛,且不延迟拔管,0.25μg/kg是较合适的剂量.Objective To investigate effects of different dosages of dexmedetomidine on preventing shivering in patients with laparoscopic colorectal surgery. Methods A total of 160 cases with ASAⅠtoⅡscheduled for laparoscopic colorec-tal surgery were randomly divided into four groups：group S,group D0.25,group D0.5 and group D0.75, 40 cases in each. At 30 minutes before surgery completing, the group D0.25,group D0.5 and group D0.75 were given dexmdetomidine 0.25μg/kg, 0.5μg/kg, 0.75μg/kg respectively. The group S was given 0.9%sodium chloride. The extubation times were observed, and MAP,HR, SpO2 and core temperature were recorded at 10 minutes,30 minutes and 60 minutes after tracheal extubation. The grade of shivering and its incidence rate were recorded at meanwhile. Results At 10 minutes,30 minutes and 60 minutes after tracheal extubation, the SpO2, temperature and MAP among four groups was not significantly different （F=1.98,2.42,2.32;1.96,1.32,2.11;1.62,1.78,2.21,P〉0.05）. Compared with group S and group D0.25, the extubation times of group D0.5 and group D0.75 were significantly longer（q=3.68,4.20;3.89,4.12,P〈0.05）. Compared with group S, the incidence rates of shivering were significantly lower in group D0.25,group D0.5 and group D0.75 （χ2=20.86, 22.74, 22.74, P〈0.05）, whereas there was no significant difference between group D0.5 , group D0.75 and group D0.25 （χ2=2.06, 2.06, P〉0.05）. The incidences of bradycardia, postoperative nausea and vomiting, delirium were significantly dif-ferent among four groups （χ2=10.71, 15.68, 15.68, P〈0.05）. Conclusion Intravenous injecting dexmedetomidine 0.25μg/kg at 30 minutes before surgery completing can effectively prevent postoperative shivering,play a role in suitable seda-tion and without the disadvantage of prolonging extubation time.

关 键 词：寒战 右美托咪定 腹腔镜肠癌手术 

分 类 号：R614[医药卫生—麻醉学] R735.3[医药卫生—外科学]