右美托咪定对重度阻塞性睡眠呼吸暂停综合征手术患者插管呛咳及苏醒躁动的影响  

Effects of dexmedetomidine on intubation choking and restlessness in patients with severe obstructive sleep apnea syndrome undergoing uvulopalatopharyngiplasty

作　　者：郑建宇 盛恒炜 黄广用 陈泽仲 ZHENG Jianyu;SHENG Hengwei;HUANG Guangyong;CHEN Zezhong(Department of Anesthesiology,Sanshui District People's Hospital,Foshan Guangdong 528100,China)

机构地区：[1]佛山市三水区人民医院麻醉科,广东佛山528100

出　　处：《中国急救复苏与灾害医学杂志》2022年第10期1336-1339,1360,共5页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的 探讨右美托咪定对重度阻塞性睡眠呼吸暂停综合征(OSAS)手术患者插管呛咳及苏醒躁动的影响。方法 选取2019年6月—2021年2月佛山市三水区人民医院收治的122例重度OSAS患者为研究对象,以随机数字表法分为研究组、对照组,每组各61例。研究组在麻醉诱导前10 min静脉滴注右美托咪定负荷剂量0.8μg/kg,之后以0.4μg/kg/h的速率持续30 min;对照组静脉滴生理盐水。对比两组围术期血流动力学指标、气管插管呛咳及镇静情况,记录两组术后苏醒时间、拔管时间、躁动发生率及疼痛情况,记录两组药物安全性。结果 两组气管插管成功即刻(T3)时刻的心率、收缩压、舒张压均高于气管插管前(T2)时刻(P<0.05),两组T2时刻的心率、收缩压均高于麻醉诱导前(T1)(P<0.05),研究组T2、T3时刻的心率、收缩压、舒张压均低于对照组(P<0.05)。研究组气管插管呛咳发生率(3.28%)低于对照组(14.75%,P<0.05)。研究组Ramsay镇静评分(RSS)为(2.89±0.43)分,高于对照组(2.47±0.38)分(P<0.05)。研究组术后苏醒时间为(9.95±4.01) min,大于对照组的(8.69±1.23) min(P<0.05),但研究组躁动发生率低于对照组(P<0.05)。两组术后24h的疼痛视觉模拟评分(VAS)均高于术后4 h、术后12 h、术后48 h(P<0.05),两组术后12 h的VAS评分均高于术后4 h、术后48 h(P<0.05),两组术后4 h的VAS评分均高于术后48 h(P<0.05);研究组术后4 h、术后12 h、术后24 h的VAS评分均低于对照组(P<0.05)。两组总不良反应发生率对比差异无统计学意义(P>0.05)。结论 右美托咪定用于重度OSAS手术患者对血流动力学影响小,且可降低插管呛咳及苏醒躁动风险,镇痛效果明显,且安全性良好。ObjectiveTo explore the effects of dexmedetomidine on symptoms(choking cough and agitation after intubation)in patients with severe obstructive sleep apnea syndrome(OSAS)undergoing uvulopalatopharyngiplasty(UPPP).Methods122 patients with severe OSAS undergoing UPPP were divided into 2 equal groups:study group receiving intravenous infusion of dexmedetomidine at a loading dose of 0.8μg/kg 10 minutes before induction of anesthesia and then at a rate of 0.4μg/(kg·h)for 30 minutes,and control group receiving intravenous infusion of normal saline in addition to midazolam,propofol,remifentanil,and cistracurium.The symptoms of tracheal intubation choking and sedation were compared between the two groups.The postoperative recovery time,extubation time,incidence of restlessness and pain were recorded.Heart rate(HR),systolic blood pressure(SBP),and diastolic blood pressure(DBP)before induction of anesthesia(T1),before the intubation(T2),and immediately after successful intubation(T3)were measured.Ramsay sedation score(RSS)was use to evaluate the sedation during tracheal intubation Visual analogue scale(VAS)was used 4 h,12 h,24 h,and 48 h after the operation to score the subjective pain perception.ResultsThe HR,SBP,and DBP at T3 in the two groups were all significantly higher than those before intubation(T2)(all P<0.05).The HR and SBP at T2 in the two groups were all significantly higher than those before T1(all P<0.05).The HR,SBP,and DBP T2 and T3 of the study group were all significantly lower than those of the control group(all P<0.05).The incidence of tracheal intubation choking of the study group was 3.28%,significantly lower than that of the control group(14.75%,P<0.05).The RSS score of the study group was(2.89±0.43),significantly higher than that of the control grop[(2.47±0.38),P<0.05].The postoperative recovery time of the study group was(9.95±4.01)min,significantly longer than that of the control group[(8.69±1.23)min,(P<0.05).The incidence of restlessness in the study group was significantly lower than that

关 键 词：阻塞性睡眠呼吸暂停综合征 右美托咪定 耳鼻喉外科手术 呛咳 躁动 

分 类 号：R614[医药卫生—麻醉学]