右美托咪啶对老年患者腹腔镜结肠癌根治术全麻恢复期质量的影响  

Effect of dexmedetomidine on quality of anesthesia recovery in elderly patients undergoing laparoscopic radical colorectomy

作　　者：邵雪泉[1] 徐玲[1] 江秀清[1] 余洁[1] 潘中心[1] 张云锋[1] 汪华娟 

机构地区：[1]衢州市人民医院麻醉科,324000

出　　处：《浙江医学》2016年第15期1266-1268,1301,共4页Zhejiang Medical Journal

摘　　要：目的评价右美托咪啶对老年腹腔镜结肠癌根治术患者全麻恢复期质量的影响。方法将择期行腹腔镜结肠癌根治术患者90例按随机数字表法分为对照组(C组)、右美托咪啶0.25μg/kg组(D_1组)和0.5μg/kg组(D_2组),每组各30例。3组患者均采用腰-硬联合加全身麻醉,于手术结束前30min D1组和D_2组患者单次静脉泵注右美托咪啶,10min内注射完毕。C组以同样方式输注0.9%氯化钠注射液。记录拔管前(T_0)、拔管时(T_1)、拔管后5min(T_2)的平均动脉压(MAP)、心率(HR)变化;观察并记录自主呼吸恢复时间、睁眼时间、拔管时间及拔管前Rikey镇静躁动评分。采用词语等级量表评分法(VRS)评估苏醒5min时疼痛程度。并记录Ste wa rd苏醒评分≥5分的时间。结果 3组患者自主呼吸恢复时间、Ste wa rd苏醒评分比较差异无统计学意义(P>0.05),C组患者在T_1、T_2时点的MAP明显增高、HR明显快于T0或D_1组和D_2组同一时点(P<0.05或0.01),与C组、D_1组比较,D_2组睁眼时间及拔管时间均略有延长(均P<0.01);与C组比较,D1组和D2组拔管前Rikey镇静-躁动评分和躁动发生率及拔管后5min的VRS评分降低,镇痛有效率升高(P<0.05或0.01)。结论手术结束前30min静脉泵注右美托咪啶0.25μg/kg可改善老年腹腔镜结肠癌根治术患者全麻苏醒期的质量。Objective To evaluate the effect of dexmedetomidine on the quality of anesthesia recovery in elderly patients undergoing laparoscopic radical colorectomy. Methods Ninety patients aged above 65 years with ASA I/II undergoing laparoscopic radical colorectomy were randomly assigned into control group （group C）, low- dose dexmedetomidine group （group D1） and high- dose dexmedetomidine group（group D2）. General anesthesia plus combined spinal and epidural anesthesia were performed on all patients, 0.25μg/kg or 0.5μg/kg dexmedetomidine was administered in groups D1 and D2, and same volume of normal saline was given in group C. The MAP and HR at pre- extubation（T0）, extubation（T1） and 5 min after extubation（T2） were recorded. The time of recovery of spontaneous respiration, time of eye- opening, time of extubation, Rikey score before extubation were documented. Verbal Rating Scale （VRS） was adopted at 5 min after emergence from anesthesia. The time when the Steward Score was 〈5 was also recorded. Results No significant differences were observed on the time of recovery of spontaneous respiration and the Steward scores （P＆gt;0.05）. The MAP and HR at T1 and T2 were significantly higher than those at T0 in group C, or those at corresponding time points in group D1 and D2 （P〈0.05 or P〈0.01）. The time of eye- opening in the group D2 was longer than that of the group C and group D1（P〈0.01）.The Rikey score, VRS score and the incidence of agitation in groups D1 and D2 were significantly lower and the rate of effective analgesia was significantly higher than those of group C （P〈0.05 or P〈0.01）. Conclusion The administration of dexmedetomidine 0.25μg/kg at 30 min prior to the surgery completion can improve the quality of anesthesia recovery in elderly patients undergoing laparoscopic radical colorectomy.

关 键 词：右美托咪啶 老年 腹腔镜结肠癌手术 麻醉恢复 

分 类 号：R614[医药卫生—麻醉学] R735.35[医药卫生—外科学]