右美托咪定用于食管癌患者全麻拔管时应激反应的临床观察

目的观察右美托咪定用于食管癌患者全麻拔管时的应激反应及其对血流动力学的影响。方法选40例择期行食管癌根治术患者,依住院号的奇偶数分为0.9%生理盐水(NS组,尾数为奇数)和右美托咪定(DEX组,尾数为偶数)组,每组各20例。两组患者在手术结束前分别静脉推注生理盐水或右美托咪定。观察两组入室时(T1)、拔管时(T2)、拔管后1、5、10min(T3、T4、T5)时的SBP、DBP、HR变化及拔管期间患者呛咳和躁动的情况。结果 NS组T3、T4、T5的SBP、DBP、HR明显高于T2(P<0.05),而DEX组无差异(P>0.05);NS组T3、T4、T5时SBP、DBP、HR明显高于DEX组(P<0.01);拔管期间,DEX组的Ramsay评分明显高于NS组(P<0.01)、呛咳评分和躁动评分显著低于NS组(P<0.01)。结论右美托咪定用于食管癌患者拔管期,能明显减少患者的应激反应与呛咳和躁动,产生良好的遗忘作用,且不延长拔管时间。

Clinical observation of stress response about dexmedetomidine been used in patients with esophageal cancer on extubation of general anesthesia

Objective To observe the stress response and hemodynamic effects of dexmedetomidine been used in patients with esophageal cancer on recoveried from general anesthesia extubation.Methods 40 patients undergoing radical resection of esophageal cancer were divided into two groups: 0.9% normal saline(NS group,n=20,the mantissa of their admission number was odd number) and dexmedetomidine(DEX group,n=20,the mantissa of their admission number was even number).Before the end of surgery,patients between two groups were intravenous injected the saline or dexmedetomidine.To observe changes of SBP,DBP,HR of patients at entering the operating room(T1),extubation(T2),after extubation1,5,10min(T3,T4,T5) and cough,restlessness of patients during wake extubation between two groups.Results There were significantly higher SBP,DBP,HR at T3,T4,T5 than that at T2 in NS group(P <0.05),but there were no significant difference in DEX group(P >0.05);There were significantly SBP,DBP,HR at T3,T4,T5,higher in NS group than in DEX group(P <0.01).Extubation period,There was significantly higher ramsay scores in DEX group than in NS group(P <0.01).There were significantly lower cough scores and agitation scores in DEX group than in NS group(P <0.01);Conclusion Dexmede-tomidine in patients scheduled for awake extubation period could significantly reduce stress response,cough and agitation in patients and produce a good amnesia,did not prolong extubation time.