右美托咪定对神经外科手术患者术中唤醒质量的影响  

Effects of Dexmedetomidine on Intraoperative Wake-up Quality of Patients Underwent Neurosurgical Operation

作　　者：杨现会[1] 白倩[1] 吕淼淼[1] 付红光[1] 孙凯[1] 董铁立[1] 

机构地区：[1]郑州大学第二附属医院麻醉科,郑州450014

出　　处：《中国药房》2016年第20期2841-2843,共3页China Pharmacy

摘　　要：目的：观察右美托咪定对神经外科手术患者术中唤醒质量的影响及安全性。方法：选取全身麻醉状态行神经外科手术患者126例,按随机数字表法分为观察组和对照组,各63例。对照组患者靶控输注丙泊酚（血浆靶浓度3~5μg/ml）和瑞芬太尼（效应室靶浓度2~6 ng/ml）行麻醉诱导和维持,唤醒前30 min将瑞芬太尼血浆靶浓度降至0.5 ng/ml;观察组患者靶控输注丙泊酚（血浆靶浓度3~5μg/ml）和瑞芬太尼（效应室靶浓度2~6 ng/ml）行麻醉诱导和维持,唤醒前30 min静脉输注盐酸右美托咪定注射液0.3μg/kg,以0.1μg/（kg·h）维持。观察两组患者术前2 h（T_1）和拔管后（T_2）平均动脉血压（MAP）、心率（HR）、收缩压（SBP）、动脉血氧饱和度（SaO_2）、血清免疫球蛋白（Ig）A、IgM、IgG、肿瘤坏死因子（T_NF）-α、白细胞介素（IL）-6、IL-8水平及唤醒期间不良反应发生情况。结果：两组患者T_1时HR、MAP、SBP、SaO_2、IgA、IgG、IgM、T_NF-α、IL-6、IL-8水平及T_2时Sa O2水平比较,差异无统计学意义（P〉0.05）;观察组患者T_2时HR、MAP、SBP、IL-6、T_NF-α、IL-8显著低于对对照组,IgA、IgM、IgG显著高于对照组,差异均有统计学意义（P〈0.05）。观察组患者呛咳的发生率显著低于对照组,差异有统计学意义（P〈0.05）;两组患者躁动、术中知晓、呼吸抑制、体动、心动过缓等不良反应的发生率比较,差异无统计学意义（P〉0.05）。结论：右美托咪定对神经外科手术患者术中唤醒质量影响较小,且能降低炎性反应,不良反应发生率低。OBJECTIVE： To observe the influence and safety of dexmedetomidine （DEX） on intraoperative wake-up quality of patients underwent neurosurgical surgery. METHODS： 126 patients with general anesthesia in neurosurgery were enrolled and randomized equally into observation group and control group, with 63 cases in each group. Control group was given target con- trolled infusion of propofol with plasma target concentration of 3-5 μg/ml and remifentanil with target effect site concentration of 2-6 ng/ml for anesthesia induction and maintenance, and then plasma target concentration of remifentanil decreased to 0.5 ng/ml 30 min before wake-up. Observation group received target controlled infusion of propofol with plasma target concentration of 3-5 μg/ ml and remifentanil with target effect site concentration of 2-6 ng/ml for anesthesia induction and maintenance, and then given DEX 0.3μg/kg intravenously 30 rain before wake-up and maintained at 0.1 μg/（kg.h）. MAP, HR, SBP, SaO_2, serum levels of IgA, IgM, IgG, IL-6, IL-8 and TNF-α were observed in 2 groups 2 h before operation （T_1） and after extubation （T2） as well as the occurrence of ADR during wake-up. RESULTS： There was no statistical significance in HR, MAP, SBP, SaO_2, IgA, IgM, IgG, IL-6, IL-8 and TNF-α levels at T1 and SaO_2 levels at T_2 between 2 groups （P〉0.05）. HR, MAP, SBP, IL-6 and TNF-α lev- els of observation group decreased significantly at T_2 and lower than those of control group; IgA, IgM and IgG increased signifi- cantly and higher than those of control group, with statistical significance （P〈0.05）. The incidence of bucking in observation group was significantly lower than control group, with statistical significance （P〈0.05）; there was no statistical significance in the incidence of ADR as dysphoria, awareness rate during operation, respiratory depression, body movement, bradycardia between 2 groups （P〉0.05）. CONCLUSIONS： DEX influence intraoperative wake-up quality of patients underwent neurosurgi

关 键 词：盐酸右美托咪定 神经外科手术 唤醒质量 

分 类 号：R614.21[医药卫生—麻醉学]