右美托咪啶减少颅内动脉瘤患者全麻气管拔管应激反应的临床观察

目的观察右美托咪啶用于颅内动脉瘤患者全麻气管拔管反应的影响。方法选择颅内动脉瘤患者20例，ASAⅠ～Ⅱ级，随机等分为两组：D组（右美托咪啶组）和N组（空白对照组）。两组手术结束前30min停用麻醉药物，并给予负荷量（舒芬太尼5pg＋格拉司琼3mg）。两组给予负荷剂量后，D组立即泵注右美托咪啶0．5gg／kg，10min内注射完毕，而N组立即泵注同等剂量的生理盐水，10min内注射完毕。观察麻醉前、用药后、拔管即刻、拔管后3、5、10min患者的心率（HR）、平均动脉压（MAP）、呼吸（RR）、血氧饱和度（SpO2）的变化，以及术后躁动率的发生和苏醒时间的比较。结果两组各时点SpO2及两组苏醒时间无显著差异（P〉0．05）。与注药前以及D组各时点比较，N组在拔管即刻、拔管3min、拔管5minHR、MAP、RR显著升高（P〈0．05）。D组各时间点三者无明显变化（P〉0．05）。D组躁动率低于N组（P〈0．05）。结论颅内动脉瘤患者手术结束前30min给予右美托咪啶0．5gg／kg泵注能明显减轻麻醉恢复期气管拔管所致的应激反应。

Clinical Observation of Dexmedetomidine in Reducing the Stress Response of the Patients with Intracranial Aneurysm to Tracheal Extubation

Objective To observe the effect of dexmedetomidine on the stress response of the patients with intracranial aneurysm to tracheal extubation. Methods 20 patients with intracranial aneurysm of ASA I-II stage were selected and randomly divided into 2 groups： group D （ dexmedetomidine group） and group N （control group ）;30 minutes before the end of operation, anesthesia was stopped in the two groups and loading dose （sulfentanyl 5ug/kg ＋ gelastronl 5mg） was given to patients in both groups, and the dexmedetomidine Sug/kg was immediately pumped intravenously in patients in group D while the same dose ofNS in patients in group N, the pumping was finished within 10 minutes; the changes of HR, MAP, RR and SpO2 of the patients in both groups before anesthesia, after drug pumping, right at the time of tracheal extubation, 3,5 and 10 minutes after tracheal extubation were observed and the incidence of restlessness and the recovery time were compared. Results There existed no difference in SpO2 at each time point and in recovery time between the two groups （P〉0.05）; the HR, MAP and RR of the patients in group N at the time point of tracheal extubation, 3 and 5 minutes after tracheal extubation were much higher than those before drug pumping and much higher than those in group D at each time point （P〈0.05） which were of no obvious changes （P〉0.05）; the incidence of restlessness in group D was lower than that in group N （P〈0.05）. Conclusions Intravenous pumping of dexmedetomidine Sug/kg to patients with intracranial aneurysm 30 minutes before the end of operation can obviously reduce the stress response to tracheal extubation in anesthesia recovery.