术中持续输注右美托咪定对胸腔镜手术患者拔管期血流动力学及苏醒质量的影响

目的 探讨术中持续输注右美托咪定对胸腔镜手术患者拔管期血流动力学及苏醒质量的影响。方法选择2018年2月—2020年8月在本院行胸腔镜手术治疗的90例患者,按随机数字表法分为研究组(45例)和对照组(45例)。研究组气管插管后开始输注右美托咪定,直至手术结束前胸腔冲洗为止。对照组在此时间段持续输注等剂量的生理盐水。比较两组血流动力学、拔管时间、呼之睁眼时间、出室时间、拔管后24 h Ramsay镇静评分、苏醒期呛咳和并发症发生情况。结果 对照组T1-T3三个时间点有创平均动脉压(MAP)、心率(HR)及血氧饱和度(SpO_(2))分别为(108.08±11.57)mmHg、(106.07±8.69)mmHg、(105.21±8.19)mmHg、(86.14±14.62)次/min、(90.05±9.18)次/min、(89.21±10.56)次/min、(103.21±3.14)%、(102.96±2.97)%、(101.96±2.24)%,明显高于T0,差异有统计学意义(t=4.600,4.354,3.980,5.972,11.140,9.548,10.614,10.538,10.173,P<0.001);研究组T1-T3三个时间点有创MAP、HR、SpO_(2)分别为(97.32±13.57)mmHg、(98.10±12.57)mmHg、(97.21±11.96)mmHg、(75.62±13.67)次/min、(73.21±6.98)次/min、(72.56±8.21)次/min、(97.04±2.08)%、(97.72±3.21)%、(97.03±2.67)%,与T0时比较,差异无统计学意义(t=0.072,0.425,0.028,1.580,0.802,0.284,0.784,1.735,0.683,P>0.05);研究组T1-T3三个时间点有创MAP、HR、SpO_(2)低于对照组,差异有统计学意义(t=4.048,3.499,3.702,3.526,9.796,8.350,10.989,8.038,9.489,P<0.001);研究组拔管时间、出室时间、拔管后24 h Ramsay镇静评分分别为(11.73±2.48)min、(20.32±3.28)min、(2.09±0.57)分,与对照组比较,差异无统计学意义(t=1.689,0.853,1.768,P>0.05);研究组呼之睁眼时间为(10.10±2.26)min,短于对照组(t=4.262,P<0.001);呛咳发生率为11.11%,低于对照组,差异有统计学意义(χ^(2)=4.444,P<0.001);两组苏醒期均无喉痉挛、呼吸抑制等并发症发生。结论 胸腔镜手术中持续输注右美托咪定能够有效维持拔管期血流动力学稳定,缩短呼之睁眼时间,减低呛咳发生风险,利于改善苏醒质量。

Effects of continuous intraoperative infusion of dexmedetomidine on hemodynamics and quality of awakening in patients undergoing thoracoscopic surgery during extubation

Objective To investigate the effect of continuous intraoperative infusion of dexmedetomidine on hemodynamics and quality of awakening in patients undergoing thoracoscopic surgery during extubation. Methods A total of 90 patients who underwent thoracoscopic surgery in our hospital from February 2018 to August 2020 were randomly divided into a trial group (45 cases) and a control group (45 cases). In the trial group, dexmedetomidine was infused after endotracheal intubation until the thoracic cavity was rinsed before the end of the operation. The control group was continuously infused with the same dose of normal saline during this period. The hemodynamics, extubation time, eye opening time during exhalation, time out of the room, Ramsay Sedation score 24 hours after extubation, choking and complications were investigated and compared between the two groups. Results The invasive mean arterial pressure (MAP) heart rate (HR), and blood oxygen saturation (SpO2) of the control group at T1-T3 were (108.08±11.57) mmHg, (106.07±8.69) mmHg, (105.21±8.19) mmHg, (86.14±14.62) times/min, (90.05±9.18) times/min, (89.21±10.56) times/min, (103.21±3.14)%, (102.96±2.97)%, and (101.96±2.24)%, respectively, which were significantly higher than those of T0 (t=4.600, 4.354, 3.980, 5.972, 11.140, 9.548, 10.614, 10.538, 10.173, all P<0.001). The invasive MAP, HR and SpO2 of the trial group at T1-T3 were (97.32±13.57) mmHg, (98.10±12.57) mmHg, (97.21±11.96) mmHg, (75.62±13.67) times/min, (73.21±6.98) times/min, (72.56±8.21) times/min, (97.04±2.08)%, (97.72±3.21)%, and (97.03±2.67)%, respectively, which were not significantly different from those of T0 (t=0.072, 0.425, 0.028, 1.580, 0.802, 0.284, 0.784, 1.735, 0.683, all P>0.05). The invasive MAP, HR and SpO2 in the trial group at T1-T3 were significantly lower than those in the control group (t=4.048, 3.499, 3.702, 3.526, 9.796, 8.350, 10.989, 8.038, 9.489, all P<0.001). The Ramsay Sedation scores of extubation time, ventricular time and 24 hours after extubation in the trial group were (11.73±2.48) min, (20.32±3.28) min and (2.09±0.57) points respectively, which were not significantly different from those of the control group (t=1.689, 0.853, 1.768, all P>0.05). The eye opening time of the trial group was (10.10±2.26) min, which was shorter than that of the control group(t=4.262, P<0.001). The incidence of choking was 11.11%, which was lower than that of the control group (χ2=4.444, P<0.001). There were no complications such as laryngeal spasm and respiratory depression in both groups during the awakening period. Conclusion The continuous infusion of dexmedetomidine during thoracoscopic surgery can effectively maintain the hemodynamic stability during extubation, shorten the eye opening time, reduce the risk of choking and cough, and improve the quality of awakening.