右美托咪啶对腹腔镜胆囊切除术病人苏醒期躁动的影响

目的:观察右美托咪啶对腹腔镜腔胆囊切除术病人苏醒期躁动（EA）的影响。方法:选择ASAⅠ~Ⅱ级的腹腔镜胆囊切除术病人60例，采用双盲法随机分为右美托咪啶组和瑞芬太尼组，每组30例。采取快速诱导气管插管静吸复合全身麻醉，右美托咪啶组于诱导前10 min采用微量泵静脉恒速泵注右美托咪啶1.0 μg/kg，随后静脉注射瑞芬太尼1 μg/kg，丙泊酚2 mg/kg，罗库溴铵0.6 mg/kg；随后持续泵注右美托咪啶0.2~0.5 μg·kg-1·h-1，丙泊酚3 mg·kg-1·h-1，瑞芬太尼0.2 μg·kg-1·min-1，七氟烷1%~2%持续吸入，罗库溴铵0.15 mg/kg间断静脉注射。瑞芬太尼组除不使用右美托咪啶外，其他与右美托咪啶组一致。观察2组病人术后复苏时间及拔管前、拔管时、拔管后10 min的EA评分情况。结果:2组病人的手术时间、自主呼吸恢复时间和呼之睁眼时间差异均无统计学意义（P>0.05）。右美托咪定组病人各时点的收缩压均低于瑞芬太尼组（P<0.05~P<0.01）；2组病人T1时心率差异无统计学意义（P>0.05），右美托咪定组病人T2和T3时心率均明显低于瑞芬太尼组（P<0.01）。右美托咪啶组拔管前、拔管时、拔管后10 min的EA评分均明显低于瑞芬太尼组（P<0.01）。结论:右美托咪定应用于腹腔镜胆囊切除术，有助于保持病人血流动力学稳定，减少病人EA的发生。

Effect of dexmedetomidine on the emergence agitation in patients treated with laparoscopic cholecystectomy

Objective: To observe the effects of dexmedetomidine on the emergence agitation(EA)in patients treated with laparoscopic cholecystectomy.Methods:Sixty patients with ASAⅠ～Ⅱ laparoscopic cholecystectomy were randomly divided into the dexmedetomidine group and remifentanil group using double blind method(30 cases each group).Two groups were treated with tracheal intubation inhalation and intravenous injection combined with general anesthesia.The dexmedetomidine group was injected intravenously with 1.0 ug/kg of dexmedetomidine before ten minutes of induction,the 1ug/kg of remifentanil,2 mg/kg of propofol and 0.6 mg/kg of rocuronium were intravenously injected,0.2～0.5 μg·kg-1·h-1of dexmedetomidine,3 mg·kg-1·h-1of propofol,0.2 μg·kg-1 ·min-1of remifentanil and 1％～2％of sevoflurane were continuously inhaled,and 0.15 mg/kg of rocuronium bromide was intermittently intravenously injected in turn in dexmedetomidine group.Except the dexmedetomidine in remifentanil group,the other drugs were used in consistent with the dexmedetomidine group.The recovery time and EA scores before extubation,at extubation and after 10 min of extubation between two groups were compared.Results:There was no statistical significance in the operation time,spontaneous breathing recovery time and eye opening time between two groups(P >0.05).The SBP in dexmedetomidine group at different time-points were lower than that in remifentanil group(P<0.05 to P<0.01).The difference of HR at T1 between two groups was not statistically significant(P>0.05),and the differences of HR in dexmedetomidine group at T2 and T3 were significantly lower than that in remifentanil group(P<0.01).The EA scores in dexmedetomidine group before extubation,at extubation and after 10 min of extubation were significantly lower than that in remifentanil group(P <0.01).Conclusions:Dexmedetomidine can maintain the stabilization of hemodynamics,and reduce the incidence of EA in patients treated with laparoscopic cholecystectomy.