右美托咪定对老年患者食管癌手术全麻苏醒期躁动及寒战的影响  

Effects of dexmedetomidine on emergency agitation and shivering in elderly patients following esophagectomy with general anesthesia

作　　者：朱牡丹[1] 赵仕浩[1] 郜宗斌 查慧杰 王萍[1] 陈金保[1] ZHU Mudan;ZHAO Shihao;GAO Zongbin;ZHA Huijie;WANG Ping;CHEN Jinbao(Department of Anesthesia,Tongling People′s Hospital,Tongling 244000,China)

机构地区：[1]铜陵市人民医院麻醉科,安徽铜陵244000

出　　处：《皖南医学院学报》2020年第4期368-371,共4页Journal of Wannan Medical College

基　　金：铜陵市卫生和计划生育委员会医学科研项目(卫科研〔2016〕1号)。

摘　　要：目的:探讨右美托咪定预防老年患者食管癌手术全麻苏醒期躁动及寒战的作用。方法:80例ASAⅠ~Ⅲ级择期行全麻食管癌手术的老年患者,随机分为右美托咪定组(D组)和对照组(C组),D组患者麻醉诱导插管前静脉泵注右美托咪定0.4μg/kg(泵注时间为15 min),然后以0.1μg/(kg·h)的速度持续静脉输注至手术结束前40 min,C组患者以相同的方式予以生理盐水。按照设定的时间记录患者麻醉期间血流动力学指标,观察两组患者苏醒时间、拔管时间、麻醉后监测治疗室(PACU)停留时间以及患者苏醒期的躁动行为、寒战情况和拔管时Ramesay镇静评分。结果:与C组比较,D组苏醒期躁动与寒战发生率减少(P<0.01),D组拔管时间略长于C组(P<0.01),但D组患者PACU停留时间短于C组患者(P<0.05),Ramesay镇静评分也稍高于C组(P<0.01)。与C组比较,D组术中麻醉镇痛药物瑞芬太尼的使用量减少(P<0.05)。D组患者HR和MAP在插管即刻(T3)均低于C组患者(P<0.01)。结论:右美托咪定可以有效预防老年患者全麻食管癌手术苏醒期躁动及寒战,并缩短患者PACU停留时间,改善患者麻醉苏醒质量。Objective:To observe the efficacy of the dexmedetomidine on the preventing emergency agitation and shivering in patients following esophagectomy with general anesthesia.Methods:80 ASAⅠ-Ⅲpatients undergoing selective esophagectomy were included and equally randomized to group D(dexmedetomidine)and group C(controls).Patients in group D underwent 0.4μg/kg dexmedetomidine by intravenous infusion 15 min before intubation followed by 0.1μg/(kg·h)until 40 min before the end of the surgery,while those in group C were managed with simple saline using the same profile in group D.Hemodynamics during anesthesia was observed according to prescheduled time points.The incidence of the emergency agitation and shivering after surgery,the awakening time,extubation time,stay at postanesthesia care unit(PACU)and the Ramesay sedation scores were recorded.Results:Patients in group D had significantly lower incidence of the emergency agitation and shivering,slightly delayed extubation,reduced PACU stay,higher Ramesay sedation scoring,decreased intraoperative dose of remifentanil,and lower HR and MAP immediately after intubation(T3)compared to those in group C(either P<0.01 or 0.05).Conclusion:Dexmedetomidine could effectively prevent emergency agitation and shivering and decrease the PACU stay time,as well as improve the quality of recovery from anesthesia in elderly patients undergoing esophagectomy with general anesthesia.

关 键 词：苏醒期躁动 寒战 老年患者 食管癌手术 右美托咪定 

分 类 号：R614[医药卫生—麻醉学] R735.1[医药卫生—外科学]