国产右美托咪啶用于高血压患者全麻气管拔管临床研究

目的：观察艾贝宁（国产右美托咪啶,dexmedtomidine,DEX）用于高血压患者全身麻醉气管拔管过程中的临床效果、不良反应和安全性。方法：选择原发性高血压Ⅰ～Ⅱ期需进行气管插管全身麻醉的手术住院患者80例,ASAⅡ～Ⅲ级术前血压控制在160/90 mmHg以下,随机分为艾贝宁组（A组,n=40）和对照组（N组,n=40）,分别于手术结束后拔管前静脉微泵注射艾贝宁0.5μg/kg或等剂量的生理盐水。观察麻醉前、用药后、拔管前、拔管即刻、拔管后3、5、10 min患者的呼吸频率（RR）、平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）、Ramsay镇静评分、躁动率以及拔管时呛咳等不良反应。结果：（1）与麻醉前相比,N组在吸痰拔管时及拔管后3、5 min MAP均明显升高,尤以拔管时明显（P〈0.05）;HR、RR加快（P〈0.05）;（2）A组拔管前血压平稳,痰拔管时及拔管后3、5 min血压及HR上升幅度较小,10 min后基本恢复至拔管前水平,组间比较差异有统计学意义（P〈0.05）;（3）与对照组比较,A组拔管时和拔管后MAP、HR差异有统计学意义（P〈0.05）;拔管时间两组间差异无统计学意义（P〉0.05）;（4）A组患者躁动发生率更低（P〈0.05）,拔管后有2例患者呼吸减浅SpO2一过性下降,面罩给氧后缓解。结论：手术结束后静脉微泵注射艾贝宁0.5μg/kg可减轻高血压全麻患者气管拔管引起的心血管反应,同时降低高血压患者全身麻醉的术后躁动率,国产的右旋美托咪啶可以安全的用于高血压患者全麻气管拔管。

Clinical observation on the patients with hypertension treated with Dexmedetomidine in tracheal extubation after general anesthesia

Objective： To Observe the effect,safety and adverse reaction of Dexmedetomidine administrated to the hypertensives during tracheal extubation after general anesthesia.Methods： 80 patients with primary high blood pressure,Ⅰ～Ⅱstage,were divided into two groups stochastically（group Dexmedetomidine,i.e.group A and group control,i.e.group N）.ASAⅡ～Ⅲ grade blood pressure was controlled below 160/90 mmHg.At the end of operation and before extubation,injection Dexmedetomidine 0.5 μg/kg with minipump was administered in group Dexmedetomidine,but in group control was intravenous injection of partes aequales physiological saline.RR,MAP,HR,SpO2,Ramsay conscious-sedation score,restlessness rate and bucking were observed and recorded before anesthesia,after administration,ahead of extubation,at the moment of extubation and after extubation 3 min,5 min and 10 min respectively.Results： Campared with before anesthesia,MAP of patients in group N rose obviously at the moment of extubation and after extubation 3 min and 5 min（P0.05）,and HR and RR speeded up（P0.05）,（2）BP,HR and RR in group A were steady,and there was significant difference in both groups（P0.05）,（3） Compared with those in group N,there was difference of MAP and HR at the moment of extubation and after extubation in group A（P0.05）.As for the timescale of extubation,there was no significant difference between both groups（P0.05）,（4） The rate of restlessness in group A was below（P 0.05）.In 2 cases,respiration decreased lightly,O2 descended temporarily,and recovered with oxygen face mask.Conclusion： The injection of Dexmedetomidine 0.5 μg/kg with minipump can suppress extubation stress and relieve restlessness due to general anaesthesia,domestic-made Dexmedetomidine can be applied to extubation on hypertensives safely.