右美托咪啶对依托咪酯-瑞芬太尼全麻后 躁动的影响

王子申+王福军+孔珉珉+孙小珊+李俊

【摘要】目的探讨手术结束前右美托咪啶的使用对依托咪酯-瑞芬太尼全麻后患者躁动的影响。方法100例择期全麻下妇科腹腔镜手术的患者, ASA I~II级, 随机分为右美托咪啶组(D组, 50例)和对照组(C组, 50例), 常规麻醉诱导：气管插管后控制呼吸。术中麻醉维持：依托咪酯靶控效应室(Arden Model)浓度为0.3 μg/ml, 瑞芬太尼0.20~0.4 μg/(kg·min)持续输注, 维库溴铵维持肌松。手术结束前30 min接静脉镇痛泵。两组患者均于手术结束前10 min停止麻醉药物的输入, 用静脉推注泵分别静脉推注生理盐水(C组)和右美托咪啶0.5 μg/kg, 推注时间均为10 min。比较两组的苏醒、拔管时间、拔管期间患者躁动的情况, 观察HR、SBP、DBP、RR的变化。结果镇静和躁动情况与T0比较, C组T2、T4、T5时镇静评分均降低(P<0.05)；D组T2、T4~T6时的镇静评分均显著升高(P<0.01), 且高于C组(P<0.01)。D组躁动程度评分均显著低于C组(P<0.01)。结论手术结束前静脉给予右美托咪啶0.5 μg/kg, 能显著减少依托咪酯静脉麻醉后所致的躁动反应, 使血流动力学更趋稳定, 且不会使患者苏醒期延长。

【关键词】右美托咪啶；全麻苏醒期；气管拔管；镇静；躁动

Effect of dexmedetomidine on agitation after etomidate-remifentanil general anesthesia WANG Zi-shen, WANG Fu-jun, KONG Min-min, et al. Department of Anesthesiology, Affiliated Hospital of Taishan Medical College, Taian 271000, China

【Abstract】Objective To investigate the effect of dexmedetomidine on agitation after etomidate-remifentanil anesthesiabefore end of surgery. Methods Chose 100 patients who under general anesthesia laparoscopic operation, ASA I~II, randomly divided them into dexmedetomidine group(group D, 50 cases) and control group(group C, 50 cases), routine anesthesia induction, after tracheal intubation, breath control, maintenance of anesthesia: etomidate target controlled effect compartment (Arden Model) concentration of 0.3 μg/ml, remifentanil 0.20~0.4 μg/(kg·min) continuous infusion, vecuronium to maintain muscle relaxation. Operation before the end of 30 min after intravenous analgesia pump. Two groups of patients in operation before the end of the 10min stop drug input, using intravenous injection pump intravenous injection of physiological saline (group C) and dexmedetomidine 0.5 μ g/kg, injection time of 10min. Compared with two groups of awakening, extubation time, extubation agitation of patients with HR, to observe the change of situation; SBP, DBP, RR. Analysis of data using SPSS 13 statistical softwar. Results Sedation and agitation conditions compared with T0 group, Ramsay score decreased at T2, T4, T5 in group C(P<0.05); group D, T2, T4~T6 Ramsay score increased significantly (P<0.01), and higher than that of group C (P<0.01). Group D agitation score was significantly lower than group C (P<0.01). Conclusion Intravenous dexmedetomidine 0.5 μg/kg before end of surgery can significantly reduce agitation etomidate intravenous anesthesia recovery period, stable hemodynamics without extending extubation time.

【Key words】Dexmedetomidine; Recovery period of general anesthesia; Tracheal extubation; Calm; Agitation

依托咪酯(etomidate)乳剂为快速、短效的静脉麻醉药, 具有反复使用、体内无蓄积、停药后恢复迅速等特点［1］, 但是依托咪酯静脉麻醉维持后, 苏醒期躁动发生率较高, 因而依托咪酯一直被排除在全凭静脉麻醉之外。右美托咪啶(dexmedetomidine, DEX)是一种新型的、选择性强的α2-肾上腺素能受体激动剂, 具有较强的镇静、镇痛、抗焦虑以及抑制交感神经兴奋的作用［2］, 已经被广泛的应用于临床麻醉中。本研究观察在腹腔镜手术近结束时使用小剂量右美托咪啶对依托咪酯所致术后躁动的影响, 为临床提供参考。

1资料与方法

1. 1一般资料经医院伦理委员会同意, 患者及其家属均签署书面同意书。选择全麻下行择期腹腔镜妇科良性肿瘤切除术100例, ASAⅠ~Ⅱ级, 年龄20~56岁, 体质量指数 16~27 kg/m2。……