不同剂量右美托咪啶持续静脉注射对甲状腺癌手术患者全麻恢复期的影响

目的 探讨不同剂量右美托咪啶对甲状腺癌患者术后苏醒质量的影响.方法 选择甲状腺癌手术患者140例.按照随机数字法分为A组46例,B组47例,对照组47例.3组患者麻醉诱导及维持方法相同.A组、B组患者于诱导后30 min内分别静脉泵入右美托咪啶0.4μg/kg和0.8μg/kg,对照组患者泵入等量生理盐水.记录右美托咪啶给药前(T0)、手术结束时(T1)、睁眼即刻(T2)、拔管即刻(T3)、拔管后10 min(T4)的心率(HR)、收缩压(SBP)和舒张压(DBP),手术开始前和结束时的PETCO2,手术结束至患者睁眼、拔管所用时间,评定苏醒躁动程度评分(RS)、镇静评分(Ramsay)和拔管后10 min疼痛视觉评分(VAS),观察拔管期间的不良反应.结果 T1、T2、T3和T4时,A组和B组患者HR显著低于对照组(P<0.05);T3、T4时,B组患者HR显著低于A组(P<0.05).T1、T2、T3和T4时,A组患者SBP显著低于对照组(P<0.05);T2、T3和T4时,B组患者SBP显著低于对照组(P<0.05);T1、T2、T3时,B组SBP显著低于A组(P<0.05).T3、T4时,A组患者DBP显著低于对照组(P<0.05);T2、T3和T4时,B组患者DBP显著低于对照组(P<0.05);T2时,B组DBP显著低于A组(P<0.05).A组、B组患者RS评分和VAS评分显著低于对照组,B组VAS评分显著低于A组.A组患者Ramsay评分显著高于对照组(P<0.05),B组患者Ramsay评分、手术结束至患者睁眼和拔管时间显著高于对照组(P<0.05),B组患者手术结束至患者睁眼和拔管时间显著高于A组(P<0.05).A组和B组苏醒期的不良反应发生率显著低于对照组(P<0.05).结论 0.4μg/kg剂量的右美托咪啶为甲状腺癌手术全麻诱导后泵入的最佳剂量,能有效预防甲状腺癌患者手术全麻恢复期应激反应,维持心率、血压的平稳,且不影响苏醒时间和拔管时间,不良反应少,使甲状腺癌手术患者获得满意的苏醒质量.

Effects of Different Doses of Dexmedetomidine Continuous Intravenous Injection of Anesthesia on General Anesthesia Convalescence of Patients with Thyroid Cancer

Objective To investigate the effect of different doses of dexmedetomidine on general anesthesia convales -cence of patients with thyroid carcinoma after surgery.Methods 140 cases of patients with thyroid cancer ,according to the ran-dom number method,were divided into group A of 46 cases,group B of 47 cases,47 cases was the control group.Anesthesia in-duction and maintenance methods were the same in the 3 groups.Patients of group A and group B were within 30 min after induc-tion respectively vein pump into dexmedetomidine 0.4 g/kg and 0.8 g/kg,and the control group ,the pump into the normal sa-line.Dexmedetomidine to medicine before(T0),and at the end of surgery(T1),eyes immediately(T2),extubation(T3),extuba-tion after 10 min(T4),heart rate(HR),systolic blood pressure(SBP)and diastolic blood pressure(DBP)were recorded,to start the operation before and at the end of P et CO2 end of surgery to the affected person eye opening ,extubation time.To assess the re-covery of agitation degree score(RS),sedation score(Ramsay)and 10min pain visual score(VAS),and adverse reactions during extubation.Results At T1,T2,T3 and T4,group A and group B of patients with HR were significantly lower than the control group(P<0.05)and at T3,T4,group B with HR was significantly lower than group A (P<0.05).At T1,T2,T3 and T4,group A with SBP was significantly lower than the control group ( P<0.05);at T2,T3 and T4,group B with SBP was significantly lower than the control group(P<0.05);at T1,T2 and T3,SBP of group B was significantly lower than that of group A (P<0.05).At T3,T4,patients with DBP of group A was significantly lower than the control group (P<0.05);at T2,T3 and T4,patients with DBP of group B significantly lower than the control group (P<0.05);at T2 the DBP of group B was significantly lower than group A(P<0.05).RS score and VAS score of group A were significantly lower than those of the control group ,Ramsay score was sig nificantly higher than that of the control group (P<0.05);RS score and VAS score of group B was significantly lower than those of the control group ,Ramsay score ,operation end to patients with eyes open and pull tube time were significantly higher than those of the control group(P<0.05);VAS scores of group B was significantly lower than that of the control group.At the end of the op-eration to patients with eyes open and pull tube time was significantly higher than that in group A (P<0.05).The incidence of adverse reactions in group A and B group was significantly lower than that of the control group (P<0.05).Conclusion The 0.4 g/kg dose of dexmedetomidine for optimal dose induced thyroid cancer surgery after general anesthesia pump.It can effectively prevent thyroid cancer patients underwent general anesthesia recovery period of stress reaction ,maintain stable blood pressure and heart rate ,and does not affect the recovery time and pull tube time and less adverse reactions ,the thyroid carcinoma patients ob-tained satisfactory recovery quality.