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右美托咪定复合依托咪酯在老年甲状腺手术患者中的应用
引用本文:史金麟,甘建辉,敖利. 右美托咪定复合依托咪酯在老年甲状腺手术患者中的应用[J]. 华西医学, 2014, 0(4): 721-724
作者姓名:史金麟  甘建辉  敖利
作者单位:[1]河北联合大学研究生学院,河北唐山063000 [2]附属唐山市人民医院麻醉科,河北唐山063000 [3]唐山市妇幼保健院麻醉科,河北唐山063000
摘    要:目的观察右美托咪定复合依托咪酯在老年甲状腺手术中的临床效果以及对术后拔管的影响。方法选择2012年7月-2013年1月行全身麻醉下甲状腺手术患者50例,美国麻醉医师协会分级Ⅰ~Ⅱ级,年龄65~75岁,男22例,女28例,体质量45~75蚝。通过随机数字表随机分成右美托咪定组(D组)以及对照组(C组),每组25例。分别于麻醉诱导后静脉泵注右美托咪定0.5μg/(kg·h)和等量生理盐水,手术结束前5min停止。术前依托咪酯0.2mg/kg诱导,术中以依托咪酯和瑞芬太尼维持。记录患者手术开始后5min(T_1)、15min(T_2)、30min(T_3),以及手术结束前15min(T_4)和5mins(T_5)的心率、收缩压、舒张压、脑电双频指数,记录患者的唤醒时间、拔管时间、苏醒期躁动例数和依托咪酯的总用量。结果①D组患者在T_2~T_5时间点心率、收缩压、舒张压较C组波动小;苏醒期躁动例数显著低于C组(P〈0.05)。②两组患者的唤醒时间和拔管时间差异无统计学意义(P〉0.05)。③D组患者术中依托咪酯的用量为(8.6士2.1)μg/(kg·min),显著少于C组(14.4士3.4)μg(kg·min)的用量(P〈0.05)。结论右美托咪定协同依托咪酯用于老年甲状腺手术中具有良好的安全性,能降低患者拔管期的心血管反应及躁动率,并减少依托咪酯的用量。

关 键 词:右美托咪定  依托咪酯  甲状腺切除术  镇静

Application of Dexmedetomidine Combined with Etomidate for Elderly Patient Undergoing thyroidectomy
SHI Jin-lin,GAN Jian-hui,AO Li. Application of Dexmedetomidine Combined with Etomidate for Elderly Patient Undergoing thyroidectomy[J]. West China Medical Journal, 2014, 0(4): 721-724
Authors:SHI Jin-lin  GAN Jian-hui  AO Li
Affiliation:1. Department of Graduate School Hebei United University, Tangshan, Hebei 063000, P. R. China; 2. Department of Anesthesia, the Affiliated Tangshan People's Hospital Hebei United University, Tangshan, Hebei 063000, P R. China; 3. Department of Anesthesia, Tangshan Maternal & Child Care Hospital Hebei 063000, P. R. China)
Abstract:Objective To observe the effect of dexmedetomidine combined with etomidate on the clinical safety and the tracheal extubation response after general anesthes I a in elderly patient undergoing thyroidectomy. Methods Fifty patients (aged between 65 and 75 years, ASA Ⅰor Ⅱ ) scheduled for thyroid surgery between July 2012 and January 2013 were randomly divided into two groups: dexmedetomidine group (group D) and control group (group C) with 25 patients in each group. Group D received dexmedetomidine of 0.5 μg/(kg·h) through intravenous infusion after anesthesia induction, and the intravenous infusion was stopped five minutes before the end of surgery. Normal saline was infused at the same volume in group C at the same time. Patients were induced with etomidate at 0.2 mg/kg for anesthesia, and etomidate and remifentanil were used for the anesthesia maintenance during the operation. Heart rate (HR), systolic blood pressure SBP), diastolic blood pressure (DBP) and bispectral index (BIS) were recorded 5 (T_1), 15 (T_2) and 30 (T_3) minutes after the beginning of the operation, and 15 (T_4) and 5 (T_5) minutes before the end of the operation. Moreover, the time of eye opening, time of extubation, the number of patients with restlessness and etomidate requirement were recorded. Results Compared with group C, HR and MAP at the time points of T2 and T5 in group D did not obviously change, but the number of restlessness patients in group D was significantly less than in group C (P 〈 0.05). There was no statistically significant difference in time of eye opening and time of extubation between the two groups (P 〉 0.05). Etomidate requirement in group D was [(8.6±2.1)μg/(kg·min)], which was significantly lower than that in group C [(14.4±3.4) μg/(kg· min)] (P 〈 0.05). Conclusion Dexmedetomidine combined with etomidate is efficient and safe for elderly patients undergoingthyroidectomy, and this method can effectively reduce cardiovascular responses to tracheal extubation, decrease the incidence of postoperative restlessness, and reduce the requirement of etomidate during the operation.
Keywords:Dexmedetomidine  Etomidate  Thyroidectomy  Sedation
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