右美托咪定预防全麻拔管期不良反应的临床观察

目的：观察使用右美托咪定后对全麻拔管不良反应的影响。方法：选择ASAⅠ～Ⅱ级．择期行腹部手术患者Bo例，随机分成S组（生理盐水组）和D组（右美托嘧啶组）．每组40例，手术结束前约30min．D组患者静脉泵注DEX0．6Hg／kg．s组泵注生理盐水。记录不同时间点的HR和MBP，患者停药至呼吸恢复、睁眼及拔除气管导管所需时间及相应时间点的丙泊酚效应室靶浓度．停药至恢复定向力和AIdrete评分》9分所需时间．以及发生术后寒战、躁动及恶心呕吐的情况。结果：D组患者HR和MBP在拔管时、拔管后1min．3min、5min及10minmt波动较S组小（P〈0．05）．拔管时丙泊酚效应室靶浓度较S组低，拔管时间延长（P〈0．05），但呼吸恢复．睁眼．定向力恢复和Atdrete评分≥9分的时间与S组相当（P〉0．05），呼吸恢复和睁眼时丙泊酚效应室靶浓度与S组也无差异（P〉0．05），s组患者发生术后寒战和术后躁动的人数明显增多（P〈0．05）。结论：右美托咪定可促进拔管时血流动力学的稳定性。有效减少术后寒战和躁动的发生．并且不会影响患者自主呼吸恢复、睁眼及停留在手术室的时间。

Clinical Observation of Using Dexmedetomidine to Prevent Adverse Reaction During Extubation

Objective： To observe the influence of dexmedetomidine to prevent adverse reaction during extubation. Methods： eighty ASA Ⅰ～Ⅱ patients, having elective abdominal surgery, were randomly divided into two groups ： group S （saline group, n=40） and group D （dexmedetomidine group, n=40）. Two groups received uniform induction and maintenance of anesthesia. 30 minutes before the end of surgery, 0.6ug/kg dexmedetomidine was given intravenously in group D and 0.9% NaCI was used instead of dexmedetomidine in group S. Heart rate （HR） and mean arterial pressure （MAP） at different time points were recorded. Duration of extubation and recovery were noted, and postoperative adverse reactions （shiver, agitated, nausea and vomiting） were also recorded. Results： Heart rate and mean arterial pressure were significantly lower in Group D than in Group S（P〈0.05） at extubation, and1, 3, 5 and 10min after extubation. The target concentrations of propofol were significantly lower in Group D than in Group S（P〈0.05） and time of extubation was prolonged in Group D, but there were no statistically significant differences between groups regarding time to spontaneous breathing, awaken, restore directional force and Aldrete scores〉9 （P〉0.05） , and the target concentrations of propofol were also no statistically significant differences between groups （P〉0.05） . The patients in group S occurred more postoperative shiver and agitated than group D （P〈0.05） . Conclusion： Dexmedetomidine can promote hemodynamic stability during extubation, effectively reduce the occurrence of postoperative shiver and agitated, and won＇t affect time to spontaneous breathing, awaken and the stay in operating room.