右美托嘧啶对OSAS病人全麻拔管期呛咳反应的影响

目的观察右美托嘧啶对阻塞性睡眠呼吸暂停综合征（OSAS）病人全麻拔管期呛咳反应影响。方法在全麻下行腭咽成形术（UPPP）OSAS病人60例,ASAⅠ～Ⅱ级,随机分为右美托嘧啶组（D组）和对照组（C组）,每组30例。D组于术毕前0.5h泵注右美托嘧啶0.8μg/kg（10min泵注完）,后以0.4μg/（kg.h）速度持续泵注至术毕;C组以同样方式泵注生理盐水。记录病人入室后（T0）、泵注右美托嘧啶即刻（T1）、泵注5min（T2）、泵注10min（T3）、拔管即刻（T4）的心率（HR）、平均动脉压（MAP）,病人苏醒时间、拔管时间及拔管时Ramsay评分和呛咳反应程度。结果 D组HR、MAP的变化较C组平稳,T3、T4时间点HR、MAP较C组明显降低（t=1.968～6.558,P〈0.05）。D组苏醒及拔管时间较C组长（t=3.551、3.743,P〈0.05）,Ramsay评分明显高于C组（t=5.765,P〈0.05）。D组呛咳发生率及剧烈程度明显低于C组（χ2=8.076,Hc=6.778,P〈0.05）。结论术毕前半小时泵注右美托嘧啶,可减少拔管期的心血管反应,提高拔管的安全性和病人的配合度。

EFFECT OF DEXMEDETOMIDINE ON BUCKING DURING TRACHEAL EXTUBATION IN PATIENTS UNDERGOING SURGERY FOR OSAS UNDER GENERAL ANESTHESIA

Objective To observe the effect of Dexmedetomidine （DEX） on bucking during endotracheal extubation in patients undergoing surgery under general anesthesia （GA） for UPPP. Methods Sixty patients with OSAS scheduled for UPPP, ASA gradeⅠ-Ⅱ, were evenly randomized to DEX group and control group. Patients in DEX group were given 0.8μg/ kg of DEX （finished in 10 rain） through a minipump, half an hour before the end of the operation, and then continuing at the rate of 0.4 μg/（kg· h） until the end of the procedure. Those in the control group were offered normal saline as the same way done for DEX group. The time of patient arrived operating room （T0）, immediate of DEX injection （T1）, five minutes after DEX injection （T2）, 10 minutes after DEX injection （T3）, the heart rate （HR） immediately after tube removal （T4）, mean arterial pressure （MAP）, palinesthesia time, extubation time, Ramsay score and extent of bucking reaction were recorded. Results Compared with patients in the control group, the HR and MAP of patients in DEX group were steady, and that at T3 and T4 were lower （t= 1. 968--6. 558,P〈0.05） The stage of analepsia and extubation time were longer （t=3. 551,3. 743;P〈0.05） ; The Ramsay score was higher （t=5. 765,P〈0.05） The incidence of bucking was lower and its intensity was milder （X2 = 8. 076, Hc = 6. 778;P〈 0.05）. Conclusion Administration of DEX by using a minipump, half an hour before the end of operation, can relieve cardiovascular effects and raise the safety of tracheal extubation, and patient＇s compliance.