摘要
目的观察术前单次预注右美托咪定对全麻手术患者麻醉药用量及拔管安全性的影响。方法择期头颈部需插管手术患者90例,ASAⅠ或Ⅱ级,手术时间3 h内,随机分成三组,每组30例。A、B两组于麻醉前预注右美托咪定1μg·kg-1,C组预注等量氯化钠注射液;B组继以右美托咪定0.2μg·kg-1·h-1微泵维持,A、C组泵入等量氯化钠注射液维持;三组其余麻醉、用药方法相同。记录三组麻醉前(T0),拔管前1 min(T1),拔管时(T2),拔管后1 min(T3)、3 min(T4)、10 min(T5)的血压和心率(HR)。记录术中七氟烷维持浓度、拔管时间,术后躁动情况,评价T2时呛咳程度评分及OAA/S评分,T4时点Ramsay镇静评分。结果 T1、T2时点A和B两组的收缩压和HR,以及T1时点两组的舒张压均低于C组(P<0.05或P<0.01),且拔管期间平均动脉压(MAP)波动小于C组(P<0.01)。B组拔管时间长于A、C两组(P<0.05),T2时点呛咳程度评分A组和B组相似(P>0.05),均低于C组(P<0.01);A、B两组T4时点Ramsay镇静评分相近(P>0.05),均高于C组(P<0.05)。术中七氟烷维持浓度A组和B组均明显低于C组(P<0.01),A、B组间无显著差异(P>0.05)。结论对手术时间短于3 h的全麻患者,术前单次预注右美托咪定增强麻醉深度效果与术前预注加术中维持相似,可减少术中全麻药用量,并降低气管导管拔管反应。
AIM To observe the effects of pre- injected a single dose of dexmedetomidine （Dex） on perioperative consumption of anesthetic and safety of extubation in general anesthesia patients with operation time within three hours. METHODS Ninety patients with ASA Ⅰ/Ⅱ scheduled for head or neck surgery （operation time within three hours） were randomly assigned into three groups （30 patients in each）. The patients in the group A and group B received Dex 1 μg·kg^-1 intravenous injection and the whole dose was given within 10 minutes, and the group C received equal volume of sodium chloride injection. Then the patients in the group B were continuously infused with Dex 1 μg ·kg-1 ·h^-1 till end of surgery, and the other groups were infused with sodium chloride injection. HR, SBP and DBP were recorded at the time points of pre- administration of Dex （To）, 1 min before extubation （T1）, extnbation （T2）, 1 min after extubation （T3）, 3 rain after extubation （T4）, 10 min after extubation （T5）. The Ramsay sedation score of T4, the cough reflex scores and OAA/S scores of T2, the time from the end of operation to extubation, consumption of anesthetics were recorded. RESULTS The SBP, HR of the group C at T1, T2 and DBP at T1 were significantly higher than those in the group A and group B （P 〈 0.05 or P 〈 0.01）. Compared with the group C, the MAP of the group A and group B were less volatile during extubation （P 〈 0.01）. The cough reflex scores, consumption of sevoflurane of the group C at T2 were significantly higher than those in the group A and group B （P 〈 0.01 ） , and Ramesay sedation score at T4 was lower （P 〈 0.01） . There were no significant difference in cough reflex scores, consumption of sevoflurane and Ramesay sedation score between group A and group B （P 〉 0.05）. The time from the end of operation to extubation of the group B was longer than those in the group A and group C （P 〈 0.05） that was no significant difference between group A and group C （P 〉 0.05）. CONCLUSION Administration of Dex before operation can reduce the consumption of sevoflurane, inhibit response of tracheal extubation in general anesthesia patients with operation time within three hours, and the anesthesia effects is similar to pre-injection combined with maintain of Dex during surgery.
出处
《中国新药与临床杂志》
CAS
CSCD
北大核心
2014年第8期604-607,共4页
Chinese Journal of New Drugs and Clinical Remedies
