摘要
目的观察术前静脉输注右美托咪定对行甲状腺手术患者术后拔除气管导管时呛咳反应的抑制效果。方法选择在全身麻醉下择期行甲状腺手术的患者80例,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级,将其随机分入右美托咪定组(右美组)和对照组,每组40例。麻醉诱导前右美组患者静脉输注右美托咪定负荷剂量1μg/kg,10 min输注完毕;对照组于同样条件下静脉输注0.9%氯化钠溶液。分别于患者入手术室后(T_0)、麻醉诱导前(T_1)、气管插管后即刻(T_2)、气管插管后1 min(T_3)、切皮前(T_4)、切皮后1 min(T_5)、手术结束时(T_6)、拔除气管导管前(T_7)、拔除气管导管后1 min(T_8)、拔除气管导管后5 min(T_9)各时间点,记录患者的心率(HR)和平均动脉压(MAP)。记录患者术中芬太尼的用量、苏醒时间(停止经静脉泵注射丙泊酚至呼之睁眼的时间)、拔除气管导管时间(停止经静脉泵注射丙泊酚至拔除气管导管的时间),以及拔除气管导管时的Ramsay镇静评分和呛咳反应程度。结果对照组T_2和T_3时间点的HR显著快于同组T_0、T_1和T_4至T_9时间点(P值均<0.05),T_5时间点的HR显著慢于同组其余时间点(P值均<0.05);T_2、T_3时间点的MAP显著高于同组T_0、T_1和T_4至T_9时间点(P值均<0.05)。右美组组内各时间点间HR和MAP的差异均无统计学意义(P值均>0.05)。对照组T_2、T_3时间点的HR显著快于右美组同时间点(P值均<0.05),T_5时间点的HR显著慢于右美组同时间点(P<0.05);T_2、T_3时间点的MAP显著高于右美组同时间点(P值均<0.05)。两组间苏醒时间和拔除气管导管时间的差异均无统计学差异(P值均>0.05),右美组的Ramsay镇静评分显著高于对照组(P<0.05),芬太尼用量显著少于对照组(P<0.05),呛咳反应阳性率显著低于对照组(P<0.05)。结论行甲状腺手术的患者术前预输注右美托咪定有助于减少呛咳反应的发生,在气管插管等手术刺激时的心血管反应轻
Objective To observe whether preoperative intravenous infusion of dexmedetomidine can inhibit cough reaction during extubation in patients undergoing thyroid surgery. Methods Eighty patients scheduled for thyroid surgery under general anesthesia （American Society of Anesthesiologists physical status I or Ⅱ grade） were randomly divided into dexmedetomidine group and placebo group, with 40 patients in each group. Dexmedetomidine （1 μg/kg） and normal saline were infused 10 min before induction of anesthesia in dexmedetomidine group and placebo group, respectively. Heart rate （HR） and mean arterial pressure （MAP） were recorded after entering the operation room （T0）, before induction （T1）, immediately after intubation （T2）, 1 min after intubation （T3）, before skin incision （T4）, 1 min after skin incision （T5）, at the end of operation （T6）, before extubation （T7）, 1 minafter extubation （T8）, and 5 rain after extubation （T9）. The fentanyl dosage, recovery time （from the stop of intravenous infusion of propofol to eyes-opening）, extubation time （from the stop ofintravenous infusion of propofol to the extubation）, Ramsay score and degree of cough were also recorded. Results In placebo group, HR in PG at T2 and T3 time points were significantly higher than those at To, T1, and T4-T9 time points （all P〈O. 05）; HR at Ts was significantly lower than those at the other time points （all P〈 0.05）. There were no significant differences in HR or MAP at different time points in dexmedetomidine group （all P〉O. 05）. HR and MAP in placebo group were significantly higher than those in dexmedetomidine group at T2 and T3 time points （all P〈O. 05）, while HR in placebo group was significantly lower than that in dexmedetomidine group at T5 （P〈0.05）. There were no significant differences in recovery time or extubation time between the two groups （both P〉O. 05）. Ramsay score in dexmedetomidine group was significantly higher than that in plac
作者
胡湘
沈亮
陆志俊
陈蕾
HU Xiang SHEN Liong LU Zhijun CHEN Lei(Department of Anesthesiology, Luwan Branch of Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200020, Chin)
出处
《上海医学》
CAS
CSCD
北大核心
2016年第10期584-587,共4页
Shanghai Medical Journal
关键词
右美托咪定
甲状腺手术
呛咳
Dexmedetomidine
Thyroid srygery
Cough reaction
