右美托咪定滴鼻预处理对全麻诱导期依托咪酯不良反应的影响

目的：观察右美托咪定术前滴鼻预处理对预防全身麻醉诱导期依托咪酯注射痛及肌阵挛的影响。方法：60例择期全麻手术者随机分为右美托咪定组（D组）和对照组（N组）,各30例。D组术前30 min鼻内滴入右美托咪定（1.0μg·kg^-1）;N组术前30 min鼻内滴入同等剂量0.9%氯化钠溶液。麻醉诱导时每组均静注依托咪酯0.3 mg·kg^-1。记录两组预给药前（T0）、给依托咪酯前（T1）及给依托咪酯后1 min（T2）、2 min（T3）的血压（BP）、心率（HR）、血氧饱合度（SPO2）;采用词语等级评分法（VRS）评估依托咪酯注射痛;观察并记录静注依托咪酯后2 min内肌阵挛发生情况。结果：与T0比较,D组HR、MAP在T1、T2、T3明显降低（P均〈0.05）,N组T2、T3明显降低（P均〈0.05）;D组HR在T1、T2、T3较N组降低（P均〈0.05）。D组MAP、SPO2在T1、T2、T3时点较N组稍降低（P均﹥0.05）;D组肌阵挛各级发生率均较N组降低（P均〈0.05）;与N组比较,D组依托咪酯注射痛的发生率和严重程度均明显降低（P〈0.05）。结论：右美托咪定术前鼻内滴注,能有效减轻麻醉诱导期依托咪酯注射痛,还可减少依托咪酯诱导所致肌阵挛的发生,提供更稳定的血流动力环境。

Effects of intranasal dexmedetomidine pretreatment on induction of general anesthesia with etomidate

Objective： To investigate the effects of etomidate injection pain and myoclonus given intranasal dexmedetomidine premedication on the induction of gereral anesthesia. Methods： Sixty cases undergone operation were randomly allocated to each group. Intranasal administrated dexmedetomidine1. 0 μg·kg^- 1（ group D n =30） or given same volume of saline（ group N n = 30） 30 min before surgery. Blood pressure（ BP）,heart rate（ HR）,oxygen saturation（ SPO2） were recorded before drug（ T0）,to etomidate before（ T1） and to 1 min（ T2） 、2 min（ T3） after etomidate. Scoring method used words（ VRS） for etomidate injection pain score; observed and recorded myoclonus occurrence within 2 min after intravenous etomidate. Results： There were no differences between two groups in all indexes before drug（ P〉 0. 05）. The SBP,HR,the VRS scores and myoclonus occurrence of group D were significantly lower than that of group N after drug（ P〈0. 05）. SPO2had no statistical significance between the two groups before and after drug（ P〉 0. 05）. Conclusions：These results suggest that the intranasal administration of dexmedetomidine in patients before operation is a safe and effective preoperation medication,Not only can effectively reduce etomidate injection pain,but also significantly reduce myoclonus occurrence induced by etomidate to provide a more stable hemodynamic conditions.