右美托咪定对开胸肺癌手术患者术后苏醒期的影响

目的：探讨右美托咪定对开胸肺癌手术患者术后苏醒期的影响。方法：选择ASAI～Ⅱ级、行开胸肺癌根治术的患者30例，随机分为2组。右美托咪定组（n=15）在麻醉诱导前静脉恒速微泵注射右美托咪定1μg·kg^-1，10min输注完毕。之后采用0．5μg·（kg·h）^-1持续静脉微泵注射，关胸时停止注射。麻醉诱导采用并丙酚TCI4μg·ml^-1，芬太尼3μg·kg^-1，爱可松0．9mg·kg^-1。对照组（n=15）静脉恒速微泵注射等速度和等容量的生理盐水。麻醉诱导采用异丙酚TCI4μg·ml^-1，芬太尼5μg·kg^-1，爱可松0．9mg·kg^-1。手术开始后右美托咪定组患者必要时采用芬太尼0．1mg静脉注射。对照组患者采用芬太尼间断静脉注射，芬太尼总量控制在8—10μg·kg^-1。记录苏醒期入苏醒室（PACU）、拔管时和出PACU时的BP、HR、SpO2。记录苏醒室中的拔管时间、血气，苏醒期躁动发生率及处理情况。结果：与对照组比较，右美托咪定组术中异丙酚、芬太尼、罗库溴铵总用量降低（P〈0．01）。与入PACU时间点比较，对照组患者拔管时的HR明显增加（P〈0．01）；右关托咪定组患者各时间点HR的差异无统计学意义。与对照组比较，右美托咪定组患者的BP、HR更加平稳（P〈0．01或0．05）。与对照组比较，右美托咪定组患者苏醒期疼痛和烦躁发生率更低（P〈0．05）。两组患者拔管时间，以及苏醒期的pH、PCO2、PO2和BE无统计学差异。结论：开胸肺癌根治术患者术中联合使用右关托咪定可降低麻醉药用量，提供苏醒期中更加优化的血流动力学，降低疼痛和烦躁的发生。

Effect of dexmedetomidine on recovery process in patients undergoing open thoracotomy of lung cancer

Objective： To investigate the effect of dexmedetomidine on recovery process in patients undergoing open thoracotomy of lung cancer. Methods： Thirty patients with I to II of ASA physical status, schedu-led for radical operations of lung cancer through thoracotomy approach, were randomly assigned into 2 groups. Patients in the dexmedetomidine group（ Group D, n = 15 ） received an infusion over 10 minutes of dexmedetodine 1 μg·kg^-1 before anesthesia induction and then an infusion of 0.5 μg·（kg · h）^ -1 for maintenance. Patients in the control group（ Group C, n = 15 ） received the same rate and volume of normal saline by infusion. Anesthesia induction was performed using propofol TCI of 4 μg·ml^-1, fentanyl 3 Ixg μg·kg^-1 for Group D and 5 μg·kg^-1 for Group C, and rocuronium 0.9 μg·kg^-1. Additional fentanyl was injected intermittently in Group D during the operation in a total dose of 8 to 10 μg·kg^-1and injected with a dose of 0.1 mg as needed in Group C. Blood pressure（ BP）, heart rate （HR）, oxygen saturation （SpO2 ）, timing of extubation, artery blood gas, adverse effects and administration during recovery process were measured and recorded. Results： Comparing with Group C, Group D experienced less dose requirement of propofol （ 125.84± 36.08） mg vs （88.75 ± 22.37） mg, P 〈 0.01 ], fentanyl （0.52±0.04） mg vs （0.35 ±0.06） rag, P 〈0.01] and rocuronium （105.38 ±15.6） mg vs （82.85 ± 18.15） rag, P 〈 0. 01 ] during operation, less haemodynamic fluctuation （ SBP, DBP and HR） during recovery process （P 〈 0. 01 or 0. 05 ）, and lower incidence of pain, restlessness and anxiety （P 〈 0. 05 ）. Conclusion： Dexmedetomidine as an adjunct to general anesthesia for lung cancer operations can decrease the requirement for anesthesia drugs, and keep stable haemodynamics, minimize adverse effects during recovery process.