右美托咪定在脊柱侧凸矫形术中的应用

观察右美托咪定对脊柱侧凸矫形术患者唤醒质量、血流动力学和术后寒战的影响。方法选择行脊柱侧凸矫形术患者40例,ASAⅠ-Ⅱ级,按随机数字表法分为右美托咪定组(D组)和对照组(C组),每组20例。D组诱导前给予右美托咪定0.5μg.kg-1静脉输注(10min输注完),继予0.5μg.kg-1.h-1速率输注至缝合切口;C组输注相同剂量生理盐水。唤醒试验开始前15min停止泵注所有麻醉药,唤醒试验结束后继续泵注。记录唤醒及麻醉苏醒时间、手术持续时间、术中相应时点平均动脉压(MAP)和心率(HR),使用血管活性药以及术后寒战发生情况,并对唤醒质量进行评价。结果 2组患者唤醒和苏醒时间差异无统计学意义(P>0.05),唤醒质量D组优于C组(P<0.05)。麻醉后各时点MAP和HR D组均低于C组(P<0.05);且术后寒战发生率D组少于C组(P<0.05)。结论在脊柱侧凸矫形术中持续输注小剂量右美托咪定能提高术中唤醒质量、维持患者血流动力学稳定,并可降低术后寒战发生率。

Application of Dexmedetomidine in Scoliosis Surgery

Objective To observe the effects of dexmedetomidine on arousal quality,hemodynamics and postoperative shivering in patients undergoing scoliosis surgery.Methods Forty patients scheduled for posterior scoliosis correction(ASA Ⅰ-Ⅱ,aged 10-25 years) were randomly divided into two groups,with 20 patients in each group.Group D was given intravenous injection of dexmedetomidine(0.5 μg·kg-1) within 10 minutes before induction,followed by an intraoperative infusion of dexmedetomidine(0.5 μg·kg-1·h-1) until the incision was sutured.Group C was only infused with an equal volume of normal saline.All infusions were discontinued at 15 minutes before awaken test,and restored after the test.Surgery duration,wake-up time,awakening time from anesthesia,intraoperative mean arterial pressure(MAP) and heart rate(HR) were recorded.Moreover,arousal quality,use of vasoactive drugs and postoperative shivering were determined.Results There were no significant differences in arousal time and awakening time from anesthesia between the two groups(P>0.05).Compared with group C,intraoperative infusion of dexmedetomidine significantly increased arousal quality and decreased MAP,HR and postoperative shivering rate(P<0.05).Conclusion Continuous infusion of small doses of dexmedetomidine can improve arousal quality,maintain hemodynamic stability and reduce the incidence of postoperative shivering in scoliosis surgery.