右美托咪啶和异丙酚对脊柱后路手术患者苏醒期躁动的影响比较

目的:以异丙酚为对照,探讨右美托咪啶对脊柱后路手术患者苏醒期躁动的影响。方法:将65例择期行脊柱后路手术美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级的患者随机分为异丙酚组(P组,n=32)组和右美托咪定组(DEX组,n=33)。两组于气管插管后分别以60μg/(kg·h)、0.5μg/(kg·h)的速率输注异丙酚、右美托咪定至手术缝合切口前。两组均于麻醉诱导前10 min(T0)、手术完成缝合切口皮肤(T1)及拔除气管导管(T2)时检测血浆C-反应蛋白(CRP)和肿瘤坏死因子-α(TNF-α)水平;记录两组苏醒期躁动的发生率及躁动程度;采用Ramsay评分评价镇静效果。结果:DEX组T1、T2观察点的CRP和TNF-α水平均低于P组,差异有统计学意义(P0.05),两组T1、T2观察点的CRP、TNF-α水平均高于T0时(P0.05);DEX组苏醒期躁动的发生率低于P组(48.5%比78.1%,P0.05),以重度躁动最为明显(3.0%比18.8%,P0.05),轻、中度躁动两组差异无统计学意义(P0.05);DEX组术毕即刻及术后6 h、12 h和24 h的Ramsay评分均高于对照组(P0.05)。结论:右美托咪定可降低脊柱后路手术患者苏醒期躁动程度及发生率,抑制炎性反应及提高镇痛效果,疗效优于异丙酚。

Influence of Dexmedetomidine and Propofol on Emergence Agitation in Patients with Posterior Spinal Surgery

Objective：To explore the influence of dexmedetomidine and propofol on emergence agitation in patients with posterior spinal surgery.Methods：Sixty-five ASA Ⅰ - Ⅱ patients undergoing selective posterior spinal surgery were randomly assigned to propofol group （P group,n =32） or dexmedetomidine group （DEX group,n =33）,and continuously received propofol and dexmedetomidine at infusion rate of 60 μg/（kg · h） and 0.5 μg/（kg · h）,respectively,before the initiation of surgical suturing.Plasma levels of C-reactive protein （CRP） and tumor necrosis factor （TNF）-α were measured in both groups at 10 min before induction of anesthesia （T0）,upon the completion of surgery suturing the skin （T1） and after extubation （T2）.The incidence and degree of emergence agitation were recorded.The degree of sedation was evaluated by Ramsay Sedation Scale.Results：The levels of CRP and TNF-a at T1 and T2 in DEX group were lower than those in P group and there were statistical difference （P＜0.05）.The levels of the above two indicators at T1 and T2 were higher than those at T0 in both groups （P＜0.05）.The incidence of emergence agitation in DEX group was lower than that in P group （48.5％ vs.78.1％,P＜ 0.05）,and the agitation severe restlessness was most distinct （3.0％ vs.18.8％,P＜0.05）,while difference in other level showed no statistical difference.The Ramsay scores in DEX group immediately,6 h,12 h and 24 h after surgery were higher than those in P group （P＜0.05）.Conclusions：The dexmedetomidine can reduce the incidence and degree of emergence agitation,inhibite inflammtory reaction,improve the effect of analgesia in patients with posterior spinal surgery,and it have better treatment effect than propofol.