右美托咪定用于高血压患者全麻苏醒期拔管管理的临床观察  

Clinical observation of dexmedetomidine during GA extubation management in patients with hypertension

作　　者：郭力甲[1] 石景辉[1] 郭雷[1] 王东春[1] 刘德胜[1] 刘宇飞[1] 李恩有[1] 

机构地区：[1]哈尔滨医科大学附属第一医院麻醉科,黑龙江哈尔滨150001

出　　处：《哈尔滨医科大学学报》2016年第5期459-462,共4页Journal of Harbin Medical University

摘　　要：]目的为选择右美托咪定用于全麻苏醒期拔管管理提供可靠依据和合适药物剂量。方法选择有高血压病史，ASAⅡ～Ⅲ患者48例，实施气管插管全身麻醉。随机分为4组，每组12例。手术结束前30min，分别在10min内静脉泵入右美托咪定0．4μg／kg（134组），0．6μg／kg（D6组），0．8μg／kg（D8组），生理盐水10mL（D0组）。记录术中用药前、用药开始后，至拔管前、拔管时、拔管后的SBP、DBP、HR。记录自主呼吸恢复时间、睁眼时间、拔管时间、定向力恢复时间、出PACU时间，以及不良事件的发生和处理。结果在给药前后D4、D6、D8组与D0组相比，在血压心率方面均有不同幅度的下降，D8组下降最明显；拔管前后，D4、D6、D8组的血压和心率的增高程度均明显低于D0组，D8组波动最小；在术后追加芬太尼和降压药用量方面，D8组明显少于其他三组；四组在自主呼吸恢复时间、睁眼时间、拔管时间、定向力恢复时间、出PACU时间上没有统计学差异。结论手术结束前静脉泵入0．8μg／kg右美托咪定，可以明显减少拔管时引起的应激反应，为全麻苏醒期提供良好的拔管条件，且不影响苏醒时间。Objective To provide a reliable basis and appropriate dose for the selection of the dexmedetomidine used for extubation management during recovery from general anesthesia. Methods Forty-eight American Society of Anesthesiologists 11 hypertnsive patients scheduled for general anesthesia were randomly divided into receive saline placebo （ Group D0）, 0. 4 μg/ kg dexmedetomidine （ Group D4）, 0. 6μg/kg dexmedetomidine （ Group D6） or 0. 8 μg/kg dexmedetomidine （Group D8） intravenously （i. v. ） 30 min before the end of surgery. Heart rate and systolic and diastolic blood pressures were measured before, during and after drug administration and tracheal extubation. The times to spontaneous breathing, eye opening, tracheal extubation and orientation recovery, and emergence from anesthesia were recorded. Adverse events such as hypertension, hypotension, tachycardia, bradycardia and pain were also recorded. Results Heart rate and blood pressures were significantly lower in the D4, D6 and D8 groups relative to group DO after drug administration （ P 〈 0. 05） and before and after tracheal extubation （ P 〈 0.05 ）. In addition, the dose of postoperative fentanyl was decreased in the D8 group relative to the other groups （P 〈 0.05 ）. There was no statistically significant difference among the four groups in recovery time to spontaneous breathing, eye opening, tracheal extubation and orientation recovery. Conclusion 0. 8 μg/kg dexmedetomidine administered 30 min before the end of surgery may stabilize hemodynamics, provide a more comfortable recovery, and reduce the need for additional rescue analgesia, without increasing recovery time.

关 键 词：右美托咪定 高血压 全麻 苏醒期 

分 类 号：R614[医药卫生—麻醉学]