右旋美托咪定对全髋置换择期手术全身麻醉患者围拔管期血流动力学及苏醒过程的影响

目的: 观察全髋置换择期手术全身麻醉患者应用不同剂量右旋美托咪定（DEX）
后围拔管期及苏醒过程血流动力学变化，为其临床应用提供理论依据。方法：拟行全髋置换
择期手术、ASA Ⅰ~Ⅱ级的患者80例，随机分为对照组和低、中、高剂量DEX组，每组20例，
术毕前30 min各组患者分别静脉泵注0、0.5、1.5和2.5 μg?kg-1　DEX，10 m
in内泵注完毕。观察并分别记录各组患者用药前（T0）、拔管前（T1）、拔管时（T2）及拔管后3 min
（T3）各时间点的收缩压( SBP)、舒张压( DBP)、心率(HR)和心肌耗氧量（MCO），同时记录苏醒时
间(t1)、拔管时间(t2)以及术后30 min（Ta）、术后35 min（Tb）、术后40 min（Tc）
3个时间点的警觉镇静评分(OAA/S)。结果：与对照组比较，T2、T3时间点，DEX低剂量组患
者SBP、DBP、HR及MCO差异无统计学意义（P>0.05），DEX中、高剂量组患者上述指标
均显著下降，差异有统计学意义（P<0.05），DEX中、高剂量组组间比较差异无统计学意义（P>0.05）。与对照组比较，DEX高剂量组患者拔管时间（t1）、苏醒时间(t2)明显延长，差异有统计学意义（P<0.05）。与对照组比较，DEX高剂量组患者OAA/S明显降低，差异有统计
学意义（P<0.05），其他3组组间比较差异无统计学意义（P>0.05）。结论：应用1.5 μg.kg-1DEX能稳定全身麻醉患者围拔管期血流动力学指标，缩短患者苏醒时间和拔管时间，维持OAA/S。
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Influence of dexmedetomidine in peri-extubation haemodynamics and analepsia process of patients with general anesthesia for total hip replacement

Abstract:Objective To observe the changes of haemodynamics during peri-extubation period and analepsia process in patients with general anesthesia for t
otal hip replacement after treated with different doses of dexmedetomidine(DEX)，and to provide theoretical basis for its application in clinic.
Methods 80 ASA Ⅰ-Ⅱ patients undergoing total hip replacement with general anesthesia were randomly divided into control group， low，moderate and high doses of DEX groups(n=20).The patients in various groups werepumped with 0，0.5，1.5 and 2.5 μg? kg-1 DEX 30 min before the end of
operation，and lasted for 10 min. The systolic blood pressure (SBP)，diastolic blood pressure (DBP) ，heart rate (HR)，myocardial oxygen consumption (MCO) of the patients in various groups before administration(T0)，before extubation(T1)， at extubation(T2)，30 min after extubation(T3) were recorded.The wake-up time(t1)，extubation time(t2)， and Observer’s Assessment of Alterness/Sedation Scores (OAA/S)at 30 min after operation(Ta)，35 min after operation(Tb)，and 40 min after operation(Tc) were also recorded.Results Compared with control group，at T2 and T3，there were no statistical differences of the SBP，DBP，HR and MCO in low doseof DEX group（P>0.05）;the SBP，DBP，HR and MCO in moderate and highdoses of DEX groups
were descended significantly，there were statistically significant differences(P<0.05);but there was no statistical difference between DEX moderate and high d
ose groups（P>0.05）.Compared with control group，the extubation time(t1) and wake-up time(t2) in high dose of DEX group were prolonged significantly，and there were statistical differences(P<0.05).Compared with control group， the OAA/Sof the patients in high dose of DEX group was reduced significantly，and there wasstatistical difference(P<0.05);but there were no statistical differences amongthe other three groups（P>0.05）.Conclusion
1.5 μg.kg-1 DEX can stablize the haemodynamics indexes of the patientswith general anesthesia during extubation，shorten the time of analepsia and e
xtubation，and sustain OAA/S.
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