右美托咪定经鼻给药在胸腔镜肺叶切除术中的疗效观察

目的 探讨不同剂量右美托咪定术前经鼻喷雾给药在胸腔镜下肺叶切除术患者中应用的安全性及有效性。方法 本研究为前瞻性随机双盲安慰剂对照临床研究，选择2017年6月~12月本院收治的90例ASAⅠ~Ⅱ级择期全麻下行胸腔镜下肺叶切除术患者，随机分为三组:麻醉诱导前45 min分别经鼻喷雾使用右美托咪定1 μg/kg（D1组）、1.5 μg/kg（D2组）和生理盐水0.01 ml/kg（C组）。观察患者用药后15 min、30 min及45 min的改良警觉镇静评分（MOAA/S），记录麻醉诱导和气管插管前后血流动力学变化，同时记录术后PACU停留时间以及躁动、恶心呕吐的发生情况。结果 D1、D2组右美托咪定经鼻喷雾给药后30 min和45 min的MOAA/S评分及用药后45 min的BIS值显著低于C组，差异有统计学意义（P＜0.05）；D1与D2组间比较，D2组给药后30 min的MOAA/S评分显著低于D1组，差异有统计学意义（P＜0.05），给药后45 min D2组的BIS值显著低于D1组，但是两组MOAA/S评分差异无统计学意义（P＞0.05）。D1、D2组患者诱导及气管插管前后心率、血压波动显著低于C组，差异有统计学意义（P＜0.05）；术后躁动和恶心呕吐的发生率均低于C组，差异有统计学意义（P＜0.05）。术后PACU停留时间比较三组差异无统计学意义（P＞0.05）。结论 右美托咪定经鼻喷雾术前给药可以安全有效地用于胸腔镜下肺叶切除术患者，提供良好的术前镇静，稳定围术期血流动力学，降低术后躁动和恶心呕吐的发生率。与1.0 μg/kg组比较，1.5 μg/kg右美托咪定经鼻给药可以显著缩短镇静起效时间。

Efficacy of Dexmetomidine in Thoracoscopic Lobectomy by Nasal Administration

Abstract:Objective To evaluate the safety and efficacy of different doses of dexmetidine in patients undergoing thoracoscopic lobectomy.Methods A prospective randomized double-blind placebo-controlled clinical study was conducted in 90 cases of ASAⅠ~Ⅱundergoing thoracoscopic lobectomy under thoracoscopic anesthesia from June to December 2017.They were randomly divided into three groups:45 minutes before anesthesia induction,dexmedetomidine 1μg/kg(D1 group),1.5μg/kg(D2 group)and normal saline 0.01 ml/kg(group C)were administered by nasal spray.Observe the modified alert sedation score(MOAA/S)at 15 min,30 min,and 45 min after medication,record the anesthesia induction and hemodynamic changes before and after tracheal intubation,and record the postoperative PACU retention time,as well as restlessness,nausea and vomiting.Results The MOAA/S scores of 30 min and 45 min after nasal spray and the BIS value of 45 min after administration in D 1,D 2 group were significantly lower than those in C group,the difference was statistically significant(P<0.05);D1 and D2 group comparison,D2 group after 30 min of MOAA/S score was significantly lower than D1 group,the difference was statistically significant(P<0.05),the BIS value of 45 min D2 group was significantly lower than that of D1 group,but there was no significant difference in MOAA/S score between the two groups(P>0.05).The heart rate and blood pressure fluctuation of patients in group D1 and D2 before and after tracheal intubation were significantly lower than those in group C,the difference was statistically significant(P<0.05).The incidence of restlessness and nausea and vomiting in group C was lower than that in group C,the difference was statistically significant(P<0.05).There was no significant difference in PACU residence time between the three groups(P>0.05).Conclusion The preoperative administration of dexmetidine by nasal spray can be used safely and effectively in patients undergoing thoracoscopic lobectomy,providing good preoperative sedation,stabilizing perioperative hemodynamics,and reducing the incidence of restlessness and nausea and vomiting after operation.Compared with 1.0μg/kg group, 1.5μg/kg dexmetidine could significantly shorten the onset time of sedation.