右美托咪定、地佐辛与曲马多对全麻苏醒恢复质量的影响  

Influence of Dexmedetomidine,Dezocine and Tramadol on the general anesthesia recovery quality

作　　者：韩明杰[1] 叶林阳[1] 

机构地区：[1]厦门大学附属第一医院麻醉科,福建厦门361001

出　　处：《中国当代医药》2018年第2期104-108,共5页China Modern Medicine

摘　　要：目的探讨右美托咪定、地佐辛与曲马多对七氟烷麻醉腹腔镜肾切除术患者苏醒期寒战、躁动及拔管期间血流动力学变化的影响。方法选取我院2016年1~10月收治的ASAⅠ~Ⅱ级择期行肾切除术的160例肾癌患者,应用随机数字表法随机分为右美托咪定(Dex)组、地佐辛(Dez)组、曲马多(Tra)组与0.9%氯化钠溶液(Con)组,每组40例。各组患者均给予七氟烷(≥0.6 MAC)持续吸入,瑞芬太尼0.15~0.30μg/(kg·min)持续泵注,维持麻醉。Dex、Dez、Tra三组患者分别在手术结束前30 min给予右美托咪定1μg/kg、地佐辛0.1 mg/kg及曲马多1 mg/kg,缓慢静脉泵注,Con组给予等容量0.9%氯化钠液体,手术缝皮时停止麻醉,观察记录四组患者术后的寒战评分、呼吸恢复时间、呼之睁眼时间、拔管时间以及各时间点及拔管后1、5、10、20、30 min的镇静躁动(Riker)评分、镇静(Rameasy)评分、HR、MAP、SpO_2。结果 Dex、Dez、Tra三组患者的寒战发生率分别为32.5%、32.5%与7.5%,显著低于Con组的57.5%(P<0.05),Tra组的寒战发生率显著低于Dex与Dez组(P<0.05)。Tra、Dez、Dex组的躁动发生率分别为40.0%、12.5%、10.0%,显著低于Con组的70.0%(P<0.05),Tra组的躁动发生率显著高于Dex与Dez组(P<0.05)。Dex、Dez、Tra组患者T3、T4、T5时的HR、MAP水平显著低于Con组(P<0.05),Con组T3、T4、T5时的HR、MBP水平显著高于T1(P<0.05)。Dex、Dez组患者T3、T4时的HR、MAP水平显著低于Tra组(P<0.05)。结论右美托咪定1μg/kg、地佐辛0.1 mg/kg、曲马多1 mg/kg手术结束前30 min静脉输注,可以有效预防七氟烷麻醉腹腔镜肾切除术患者术后寒战及躁动的发生,降低拔管期血流动力学的波动。Objective To explore the influence of Dexmedetomidine,l）ezocine and Tramadol on postoperative shivering and emergence agitation in patients anesthetized with Sevoflurane undergoing laparoscopic nephrectomy,and haemodynamic stability during extubation.Methods 160 patients with kidney cancer in our hospital,American Society of Anesthesiologists （ASA） I - Ⅱ,undergoing laparoscopic nephrectomy from January to October in 2016 were selected and divided into the Dexmedetomidine （Dex） group,the Dezocine （Dez） group,the Tramadol （Tra） group,the 0.9% Sodium Chloride Solution （Con） group according to the random number table method,40 cases in each group.All patients were anesthetized with Sevoflurane （〉10.6 MAC） supplemented by Remifentanil 0.15-0.30 Ixg/（kg＇min） after anesthesia induction.The Dex group received 1 mg/kg of Dexmedetomidine,the Dez group received 0.1 mg/kg of Dezocine,the Tra group received 1 mg/kg of Tramadol,the Con group received 0.9% normal saline 30 minutes before the end of surgery.The incidence of postoperative shivering and emergence agitation,the time of autonomous respiration,eye opening,extubation and the mean arterial pressure （MAP）,hear rate （HR）,Riker Sedation-Agitation Scale and Rameasy sedation score,SpO2 were compared at the last three time points and 1,5,10,20,30 min after extubation.Results The incidence of shivering in the three groups of Dex,Dez and Tra were 32.5%,32.5% and 7.5% respectively,which was significantly lower than that of the Con group （57.5%） （P〈0.05）,the incidence of shivering in the Tra group was significantly lower than that in the Dex and Dez group （P〈0.05）.The incidence of emergence agitation in the Tra,Dez and Dex groups were 40.0%,12.5% and 10.0%,respectively,which was significantly lower than that in the Con group （70.0%） （P〈0.O5）.The incidence of e- mergence agitation in the Tra group was significantly higher than that in the Dex and Dez group （P〈0.05）.The levels of HR and MAP in the Dex,Dez,

关 键 词：右美托咪定 地佐辛 曲马多 寒战 躁动 血流动力学变化 

分 类 号：R614.2[医药卫生—麻醉学]