右美托咪定对丙泊酚合并瑞芬太尼麻醉下脑功能区手术术中唤醒效果的影响

目的 探讨右美托咪定对丙泊酚合并瑞芬太尼麻醉下脑功能区手术术中唤醒效果的影响.方法 选择择期行大脑功能区手术的患者32例,美国麻醉师协会（American Association of anesthetists, ASA）Ⅰ～Ⅱ级,随机分为右美托咪定组（D组）和生理盐水对照组（C组）,两组均采用全凭静脉麻醉,静脉注射芬太尼、依托咪酯、顺阿曲库铵行麻醉诱导,1％丁卡因行喉头及气管内粘膜表面麻醉后气管插管.分别在麻醉诱导前给予1 μg/kg右美托咪定和等量生理盐水在10 min内静脉注入,术中D组持续泵入右美托咪定0.2 μg/（kg.h）,C组泵入等量的生理盐水.唤醒试验开始时两组停用麻醉维持药物（除右美托咪定和生理盐水外）,观察并记录麻醉诱导前10 min（T1）、诱导后即刻（T2）、停药即刻（T3）、唤醒即刻（T4）、加深麻醉5 min后（T5）的平均动脉压（Mean arterial pressure,MAP）、心率（heart rate,HR）;记录唤醒时间、唤醒成功率、每分钟呛咳次数和体动次数.结果 两组的唤醒成功率相同,D组唤醒时间比C组长但无统计学意义（P＞0.05）,D组的呛咳次数和体动次数明显少于C组（P＜0.05）,T1、T5时两组HR、MAP比较差异无统计学意义（P＞0.05）;两组间HR、MAP在T3、T4时比较有统计学意义（P＜0.05）,对照C组明显高于试验D组.结论 右美托咪定有助于脑功能区手术患者全麻诱导及术中唤醒时血流动力学的稳定,并不延长唤醒时间,能减轻患者应激反应,提高唤醒质量,减少了不良事件的发生.

Effect of Dexmedetomidine on awakening of operation in the brain function area with Propofol and Remifentanil anesthesia

Objective Effect of Dexmedetomidine on awaking of operation in the brain function area with Propofol and Remifentanil anesthesia is discussed. Method A total of 32 patients underwent selective operation in cerebral functional area with American Association of anesthetists（ ASA） grade I ~ II,were randomly divided into Dexmedetomidine group（ group D） and physiological saline control group（ group C）.Both two groups were treated with total intravenous anesthesia,intravenous fentanyl,etomidate,cisatracurium anesthesia induction,and anesthesia were carried out through tracheal intubation after laryngeal and tracheal mucosal surface anesthesia with 1% tetracaine. A total of 1 μg / kg dexmedetomidine and normal saline were injected before induction of anesthesia. During the operation the patients in group D underwent continuous infusion of dexmedetomidine 0. 2 μg / kg·h and group C were pumped saline. At the beginning of the trial,anesthesia drug maintenance（ except for dexmedetomidine and saline） was stopped in two groups. Mean arterial pressure（ MAP） and heart rate（ HR） were observed and recorded at 10 min before induction of anesthesia（ T1）,immediately after induction（T2）,stop drug instantly（T3）,wake up immediately（T4）,5 min after deep anesthesia（ T5）. Waking up time,success rate of waking up,cough frequency and movement per minute were recorded. Results The success rate of waking up was the same in two groups. There was no statistical significance in the waking up time between group C and group D（ P 0. 05）. There was significant difference in number of coughs and movement between group C and D（ P 0. 05）. There was no significant difference in HR and MAP at T1,and T5 between group C and D（P 0. 05）; HR and MAP at T3 and T4were much higher than those of group D with a significant statistical difference（P 0. 05）. Conclusion Dexmedetomidine is beneficial for the stability of hemodynamic in patients underwent operation of cerebral functional area during general