右旋美托咪啶-丙泊酚静脉麻醉在甲状腺切除术中的应用

目的探讨右旋美托咪啶在甲状腺切除术中作为临床麻醉用药的安全性和有效性。方法选择甲状腺择期手术全麻患者40例(ASAⅠ～Ⅱ级),随机分成2组各20例。D组诱导前给予右旋美托咪啶1μg/kg缓慢静注(10 min以上),继以0.4～1μg/(kg.h)静脉输注维持麻醉;R组诱导前给予雷米芬太尼1μg/kg缓慢静注(10 min以上),继以0.05～1μg(kg.min)静脉输注维持麻醉。2组均同时静脉输注5～10 mg/(kg.h)丙泊酚维持脑电双频指数(BIS)在40～50。记录给药前后、插管前后患者心率(HR)、动脉血压(SBP、DBP、MAP)、OAA/S镇静评分、Ramesay镇静评分;术中每15 min记录患者HR、SBP、DBP、MAP;观察停止麻醉后患者自主呼吸恢复时间、初醒(呼之睁眼)时间、清醒拔管时间、在术后恢复室停留时间及相关并发症情况;随访术中知晓的发生情况;计算丙泊酚的输注量。结果 D组患者在静注右旋美托咪啶后MAP无明显变化(P均>0.05),HR明显降低(P<0.01),OAA/S及Ramesay镇静评分降低(P均<0.05),插管后MAP升高(P<0.05);R组患者在静注雷米芬太尼前后HR无明显变化(P>0.05),OAA/S及Ramesay镇静评分无明显变化(P均>0.05),插管后MAP升高(P<0.05);麻醉维持期间,D组MAP高于R组(P<0.05),HR低于R组(P<0.05);2组自主呼吸恢复时间及恢复室停留时间无明显差异(P均>0.05),D组初醒时间、清醒拔管时间长于R组(P均<0.05);2组间恶心呕吐、寒战等并发症的发生率无明显差别(P均>0.05),术后随访均未发现术中知晓情况的发生;D组患者丙泊酚的需要量明显低于R组(P<0.01),术后早期R组患者即需要额外镇痛药。结论右旋美托咪啶-丙泊酚和雷米芬太尼-丙泊酚静脉麻醉均适用于择期甲状腺切除手术患者,2种方式术中血流动力学稳定性及并发症的发生率相似,右旋美托咪啶-丙泊酚的方式虽术后认知功能恢复稍晚,但对术后镇痛的要求降低,更有效减少额外镇痛药带来的并发症。

Application of dexmedetomidine-propofol intravenous anesthesia in patients undergoing thyroidectomy

Objective It is to observe the clinical efficacy and safety of dexmedetomidine intravenous anesthesia in patient undergoing thyroidectomy.Methods 40 patients with ASA Ⅰ or Ⅱ that scheduled for thyroid surgery were randomly divided into 2 groups with 20 cases in each.The patients in Group D were received preintubation medication of dexmedetomidine 1 ug / kg infused over 10 min followed by iv infusion of dexmedetomidine 0.4 to 1 μg /(kg.h).and in Group R were received preintubation medication of remifentanil 1 ug / kg infused over 10 min followed by iv infusion of dexmedetomidine 0.05 to 1 μg /(kg.min).Propofol was administered 5 to 10 mg/(kg.h) iv infusion in both groups to maintain BIS values at 40 to 50.HR,SBP,DBP,MAP,OAA / S score and Ramesay score were measured before and after medication and endotracheal intubation.HR,SBP,DBP,MAP were recorded every 15min.Recovery time of spontaneous ventilation,early awake time(open eyes by calling),extubation time,staying time at PACU,relevant complications and incidence of awareness were observed.Total dose of propofol infusion were calculated.Results In group D,there was no significant difference in MAP after medication of dexmedetomidine,but HR,OAA / S and Ramesay score were lower;MAP were higher after endotracheal intubation.In group R,there were no significant differences in HR,OAA / S and Ramesay score after medication of remifentanil,but MAP were higher after endotracheal intubation.MAP was higher in group D than that of group R.HR were lower in group D than that of group R.There were no significant differences in recovery time of spontaneous ventilation,staying time at PACU and incidence of complications(including nausea,vomit,and shiver) between both groups.Early awake time and extubation timein group D were longer than that of group R.Awareness did not occurred in both groups.Total dose of propofol were minor in group D than that of group R.Patients needed extra analgesics early postoperation in group R.Conclusion Both dexmedetomidine-propofol and remifentanil-propofol intravenous anesthesia are suitable for patients undergoing selective thyroidectomy.There is no significant difference in hemodynamic stability and incidence of complications between both groups.Dexmedetomidine make recovery time of postoperative cognitive dysfunction longer,but Dexmedetomidine can reduce the requirement of analgesics and the attendant complications caused by analgesics.