右美托咪啶治疗全身麻醉后重度寒战效果观察

目的观察右美托咪啶（Dexmedetomidine,Dex）静脉注射治疗全身麻醉后重度寒战的安全性和有效性。方法选择静吸复合全身麻醉行胸、腹部、泌尿、骨科手术后麻醉复苏早期出现寒战、强度分级为4级的患者60例。ASAⅠ～Ⅱ级,年龄20～60岁,体重50～70kg,随机分为两组,均在出现重度寒战时注药,Ⅰ组（Dex组）给予右美托咪啶0.2～0.3μg/kg,用生理盐水稀释至10ml,当寒战完全停止时（显效）停药;Ⅱ组（曲马多组）给予曲马多1～2mg/kg。观察两组患者寒战的转归情况。结果①Dex治疗全身麻醉后重度寒战的效果明显优于曲马多;②Dex小剂量静脉缓慢注射治疗寒战时,患者血流动力学稳定,有一定的镇静作用且无头昏、恶心呕吐等症状,与曲马多比较差异有统计学意义（P〈0.05）;③Dex治疗寒战术中无寒战再发征象。结论 Dex静脉注射能迅速解除寒战,降低寒战阈值,可减少寒战复发,安全可靠,有一定的临床价值。

Clinical effect of dexmedetomidine on the shivering after anesthesia

Objective To observe the safety and reliability of Dex treatment of shivering after general anesthesia.Methods Sixty shivering patients undergoing thoracic surgery,urology surgery or orthopaedics surgery were randomly allocated to two groups(30 cases in each group).The intensity of shivering after general anesthesia was grade as 4.When shivering occurs,0.2～0.3 μg/kg of Dex diluted with saline to 10 ml was slowly injected,withdrawed as soon as the shivering stops,and 1～2 mg/kg of tramadol were injected intravenously in groupⅡ.Results ①The dexmedetomidine curative effect to the shivering after general anesthesia is much better than tramadol ②The shivering patients with Dex slow intravenous injection of small doses had stable hemodynamics.Slow intravenous injection of low dose Dex can quickly relieve the chills of patients,with a certain degree of sedation and no dizziness,nausea,vomiting and other symptoms.The incidence of side effects was significant differences between Dex and tramadol(P<0.05).③The shivering treated with Dex was no recurrence.Conclusion Dex by intravenous injecting can rapidly relieve chills,decrease the shivering threshold,reduce recurrence of shivering.The safety and Clinical value are positive.