右美托咪定对全身麻醉患者气管拔管期应激反应的临床观察

目的探讨右美托咪定对全身麻醉患者气管拔管期应激反应的影响，提高气管拔管安全性。方法选取全身麻醉患者80例，按照随机数字表法将其分为观察组和对照组各40例，观察组于麻醉恢复室苏醒期给予右美托咪定，对照组给予同等容量的0．9％氯化钠注射液，观察不同时间点二组患者血流动力学指标、RSS镇静评分、躁动及不良反应等。结果二组手术一般情况各项指标比较，差异均无统计学意义（P〉0．05）。观察组各时间点HR、SBP及DBP水平比较，差异无统计学意义（P〉0．05）；对照组拔管即刻（T3）和拔管后（T4、T5）HR、SBP及DBP水平较拔管前（T1、T2）显著增高（P〈0．05），拔管后20min（T6）恢复至拔管前（P〉0．05）。二组T1、T2、T6时间点HR、SBP及DBP水平相似，差异无统计学意义（P〉0．05）；T3、T4及T5时间点对照组HR、SBP及DBP水平均高于观察组，差异有统计学意义（P〈0．05）。二组各时间点SpO2水平比较，差异无统计学意义（P〉0．05）。观察组T3、T4、T5及T6各时间点RSS镇静评分均高于对照组，差异有统计学意义（P〈0．05）。观察组T4、T5时间点RSS镇静评分明显高于T3时间点，差异有统计学意义（P〈0．05）。观察组躁动发生率5．00％，明显低于对照组的27．50％，差异有统计学意义（P〈0．05）。观察组不良反应发生率为37．50％，与对照组的40．00％相似，差异无统计学意义（P〉0．05）。结论全身麻醉患者苏醒期给予适量右美托咪定，能维持拔管期间患者血流动力学的稳定，降低躁动发生率，可有效预防全身麻醉苏醒拔管期应激反应。

CLINICAL OBSERVATION ON THE EFFECTS OF DEXMEDETOMIDINE ON THE STRESS REACTION IN PATIENTS UNDER GENERAL ANESTHESIA IN TRACHEAL EXTUBATION PERIOD

Objective To investigate the effects of dexmedetomidine on the stress reaction in patients under general anesthesia in tracheal extubation period and to elevate the safety of tracheal extubation. Methods Eighty patients under general anesthesia were selected and randomly divided into observation group and control group, 40 patients each group. The observation group was given with dexmedetomidine in the stage of analepsia at the anesthetic recovery room, while the control group was given with the same volume of 0.9 % sodium chloride injection, and the hemodynamics indexes, RSS sedation scores, restlessness and adverse reactions and so on of the patients in two groups were observed at different time points. Results The differences in each index of general operative conditions between the two groups were all statistically insignificant （P〉0. 05）. The differences in HR, SBP and DBP levels at each time point of the observation group were all statistically insignificant （P〈0.05） ; HR, SBP and DBP levels when extubation （T3） and after extubation （T4 and T5） of the control group were significantly （P〈0.05） higher than those before extubation （T1 and T2）, and the levels in 20min after extubation （T6） recovered to the levels before extubation （P〉0.05）. HR, SBP and DBP levels of the two groups at T1, T2 and T6 were similar, and the differences were statistically insignificant （P〉0.05）; while at T3, T4 and T5, HR, SBP and DBP levels of the control group were all higher than those of the observation group, and the difference were statistically significant （P〈0.05）. The differences in SpO2 levels at each time point between the two groups were statistically insignificant （P〈0.05）. RSS sedation scores at T3, T4, T5 and T6 of the observation group were all higher than those of the control group, the differences were statistically significant （P〈0.05）. RSS sedation scores at T4 and T5 of the observation group were significantly higher than that at T3, the differences were statistically significant （P〈0.05）. The incidence of restlessness of the observation group was 37.50%, similar with that of the control group （40.00%）, and the difference was statistically insignificant （P〉0.05）. Conclusion Giving an appropriate amount of dexmedetomidine in the stage of analepsia in patients under general anesthesia can maintain the stability of the hemodynamics, decrease the incidence of restlessness and effectively prevent from the stress reaction in tracheal extubation period after general anesthesia.