右美托咪定减轻颅脑手术拔管反应的临床观察

目的观察右美托咪定抑制颅脑手术患者拔管反应的临床效果。方法 60例行开颅手术患者随机分成2组,所有患者在手术结束前30min静脉推注(>10min)右美托咪定0.5μg/kg(DEX组)或0.9%氯化钠注射液(NS组)。分别记录患者诱导前(T0)、入麻醉后恢复室(PACU)即刻(T1)、拔管即刻(T2)和拔管后5min(T3)的收缩压(SBP)、舒张压(DBP)、心率(HR)和脉搏血氧饱和度(SpO2),相应计算出拔管前后血流动力学变化差值(△SBP、△DBP、△HR),抽取相应时段血液测定血浆肾上腺素(AD)及去甲肾上腺素(NE)浓度,并记录2组患者拔管反应发生率。结果同NS组比较,DEX组T2、T3时SBP、DBP、HR、血浆AD及NE浓度明显低于NS组(P<0.05);同NS组比较,DEX组SBPmax、DBPmax、HRmax及△SBP、△DBP、△HR降低(P<0.05);同NS组拔管反应(67%)比较,DEX组发生率(10%)明显降低(P<0.05)。结论右美托咪定用于颅脑手术患者可以抑制拔管期间心血管反应,减轻拔管反应,具有良好的临床效果。

The effect of extubation reaction in craniocerebral surgery using dexmedetomidine

Objective To observe the efficacy of dexmedetomidine(DEX) during endotracheal extubation in craniocerebral surgery.Methods Sixty patients undergoing craniotomy were randomized into two groups.Thirty mins before the surgery,dexmedetomidine at a dose of 0.5 μg/kg in group DEX(n=30) and saline in group NS(n=30) were administrater intravenously over 10 min.SBP,DBP,HR and SpO2 were recorded at different time(before induction,at the time to PACU,at the time of extubation and 2 mins after extubation).Then △SBP,△DBP and △HR were calculated.We also recorded the level of AD and NE for each time.Results Compared with NS group,DEX group had much lower change in SBPmax,DBPmax,HRmax,△SBP,△DBP,△HR,AD and NE at time T2,T3(P<0.05).The incidence of extubation reaction in DEX group(10%) was also lower than that in NS group(67%)(P<0.05).Conclusion General anesthesia using dexmedetomidine in craniocerebral surgery could decrease the fluctuation of hemodynamics and depress extubation reaction.