右美托咪定对脊柱矫形术中唤醒试验效果的影响研究

目的探讨右美托咪定在脊柱矫形手术患者唤醒试验的应用效果。方法将80例脊柱矫形手术患者随机分为试验组和对照组，每组40例，两组均采用气管捅管全麻，麻醉诱导方式相同，试验组在诱导前给予右美托咪定0．8μg／（kg·h）（10min内输注完），术中继予0．5μg／（kg·h）速率输注至缝合切口。对照组给予等量的生理盐水，唤醒试验开始前15min停止泵注所有麻醉药，唤醒试验结束后继续泵注。比较两组患者的唤醒时间、唤醒质量，唤醒前15min（T1）、自主呼吸恢复时（T2）、唤醒即刻（T3）、唤醒后15min（T4）的血液动力学变化，麻醉药的用量以及不良事件的发生率。结果两组唤醒前手术时间差异无统计学意义（P=0．07）。试验组的唤醒前七氟醚、舒芬太尼的用量显著少于对照组（P=0．03，P=0．00）。试验组的唤醒时间、唤醒期间出血量显著少于对照组，唤醒质量显著高于对照组（P=0．04，P=0．00，P=0．03）。试验组唤醒时的血压和心率显著低于对照组（P=0．00，P=0．00）。试验组唤醒不良事件的发生率显著少于对照组（P=0．04）。结论右美托咪定应用于脊柱矫形手术，能显著提高患者的唤醒质量，缩短唤醒时间，减少唤醒时的出血量和唤醒后的不良事件，且能维持血液动力学的稳定，具有较好的保护效应。

Influence of Dexmedetomidine on Wake-Up Test during Spinal Orthopaedic Surgery

Objective To explore the influence of dexmedetomidine on wake-up test during spinal orthopaedic surgery. Methods All 80 patients taking spinal orthopaedic surgery were randomly divided into the trial group and the control group, with 40 cases in each group. The endotracheal intubation anesthesia was adopted in both groups with same anesthesia induction. Additionally, dexmedetomidine 0.8 μg/ （kg.h） was infused within 10 min in the trial group before anesthesia induction, and then another 0.5 μg/（kg.h） was also infused from the intraoperation to suture of inci- sion. For the control group, the same amount of normal saline was infused, and all the narcotics were stopped pumping 15 min before the wake-up test, but then were continued pumping after the wake-up test. Finally, the following indexes were analyzed： wake-up time, wake-up quality, hemodynamic changes at the time of 15 min before wake-up （T1）, recov- ery of spontaneous breathing （T2）, wake-up （T3） and 15 min after wake-up （T4）, dosage of narcotics, and the incidence of adverse events. Results There was no significant difference in the operation time before wake-up between the two groups （P=0.07）. For the trial group, the dosage of sevoflurane （P=0.03） and sufentanil （P=0.00） used before wake-up was significantly lower, the wake-up time （P=0.04） and bleeding amount during wake-up （P=0.00） were significantly less, the wake-up quality （P=0.03） was significantly higher, the blood pressure （P=0.00） and heart rate （P=0.00） when wake-up were significantly lower, and the incidence of adverse events （P=0.04） was significantly lower, compared with the control group. Conclusion Dexmedetomidine adopted in spinal orthopaedic surgery can significantly improve patient＇s wake- up quality, shorten wake-up time, reduce bleeding amount when wake-up and adverse events after wake-up, and maintain the hemodynamic stability, so it has better protective effects.