中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2014年
4期
239-243
,共5页
赵晓春%佟冬怡%龙波%吴秀英
趙曉春%佟鼕怡%龍波%吳秀英
조효춘%동동이%룡파%오수영
右美托咪定%全身麻醉%苏醒%甲状腺切除术
右美託咪定%全身痳醉%囌醒%甲狀腺切除術
우미탁미정%전신마취%소성%갑상선절제술
Dexmedetomidine%General anesthesia%Recovery%Thyroidectomy
目的 观察两种不同剂量右美托咪定对甲状腺手术全麻患者苏醒期质量的影响.方法 采用前瞻性随机对照双盲研究方法,选择中国医科大学附属盛京医院择期行甲状腺手术患者90例,按随机数字表法分为对照组和右美托咪定0.4μg/kg组、0.8μg/lkg组(D0.4组、D0.8组)3组,每组30例.分别于诱导插管后30 min内静脉泵入相应剂量右美托咪定或等量生理盐水.记录给药前、手术结束时、睁眼即刻、拔管即刻、拔管后10 min的心率(HR)、收缩压(SBP)和舒张压(DBP);记录术毕至睁眼时间和拔管时间以及术前、术毕时呼气末二氧化碳分压(PETCO2),评价苏醒躁动程度评分(RS)、镇静评分(Ramsay)和拔管后10 min疼痛视管模糊评分(VAS),以及拔管期间不良事件,如呛咳、恶心呕吐、呼吸抑制等.结果 ①睁眼即刻、拔管即刻、拔管后10 min时,D0.4组和D0.8组HR、SBP和DBP均明显低于对照组;其中D0.8组拔管即刻、拔管后10 min时HR均低于D0.4组,睁眼即刻、拔管即刻SBP均低于D0.4组,睁眼即刻DBP明显低于D0.4组.②D0.4组和D0.8组RS评分、VAS评分低于对照组,Ramsay评分高于对照组[RS(分):1.40±0.51、1.20±0.42比1.90±0.56,VAS(分):1.50±0.52、0.80±0.63比2.50±0.52,Ramsay(分):2.10±0.56、2.40±0.51比1.60±0.51,P＜0.05或P＜0.01];且D0.8组VAS评分明显低于D0.4组(P＜0.01).D0.8组术毕至睁眼时间和拔管时间明显长于对照组和D0.4组(min:12.50 ± 1.08比10.50±1.58、10.40±1.26,15.00±0.94比13.00±1.63、12.80±1.13,P＜0.05或P＜0.01),而对照组与D0.4组之间均无差异.3组患者术前及术毕PETCO2比较差异均无统计学意义.③对照组呛咳反应和恶心呕吐发生率(16.7％、13.3％)均明显高于D0.4组(3.3％、0)和D0.8组(0、0);3组患者均无呼吸抑制发生.结论 麻醉诱导后30 min泵入0.4μg/kg右美托咪定可使甲状腺手术全麻患者苏醒期HR和血压更平稳,且能缩短苏醒时间和拔管时间.
目的 觀察兩種不同劑量右美託咪定對甲狀腺手術全痳患者囌醒期質量的影響.方法 採用前瞻性隨機對照雙盲研究方法,選擇中國醫科大學附屬盛京醫院擇期行甲狀腺手術患者90例,按隨機數字錶法分為對照組和右美託咪定0.4μg/kg組、0.8μg/lkg組(D0.4組、D0.8組)3組,每組30例.分彆于誘導插管後30 min內靜脈泵入相應劑量右美託咪定或等量生理鹽水.記錄給藥前、手術結束時、睜眼即刻、拔管即刻、拔管後10 min的心率(HR)、收縮壓(SBP)和舒張壓(DBP);記錄術畢至睜眼時間和拔管時間以及術前、術畢時呼氣末二氧化碳分壓(PETCO2),評價囌醒躁動程度評分(RS)、鎮靜評分(Ramsay)和拔管後10 min疼痛視管模糊評分(VAS),以及拔管期間不良事件,如嗆咳、噁心嘔吐、呼吸抑製等.結果 ①睜眼即刻、拔管即刻、拔管後10 min時,D0.4組和D0.8組HR、SBP和DBP均明顯低于對照組;其中D0.8組拔管即刻、拔管後10 min時HR均低于D0.4組,睜眼即刻、拔管即刻SBP均低于D0.4組,睜眼即刻DBP明顯低于D0.4組.②D0.4組和D0.8組RS評分、VAS評分低于對照組,Ramsay評分高于對照組[RS(分):1.40±0.51、1.20±0.42比1.90±0.56,VAS(分):1.50±0.52、0.80±0.63比2.50±0.52,Ramsay(分):2.10±0.56、2.40±0.51比1.60±0.51,P＜0.05或P＜0.01];且D0.8組VAS評分明顯低于D0.4組(P＜0.01).D0.8組術畢至睜眼時間和拔管時間明顯長于對照組和D0.4組(min:12.50 ± 1.08比10.50±1.58、10.40±1.26,15.00±0.94比13.00±1.63、12.80±1.13,P＜0.05或P＜0.01),而對照組與D0.4組之間均無差異.3組患者術前及術畢PETCO2比較差異均無統計學意義.③對照組嗆咳反應和噁心嘔吐髮生率(16.7％、13.3％)均明顯高于D0.4組(3.3％、0)和D0.8組(0、0);3組患者均無呼吸抑製髮生.結論 痳醉誘導後30 min泵入0.4μg/kg右美託咪定可使甲狀腺手術全痳患者囌醒期HR和血壓更平穩,且能縮短囌醒時間和拔管時間.
목적 관찰량충불동제량우미탁미정대갑상선수술전마환자소성기질량적영향.방법 채용전첨성수궤대조쌍맹연구방법,선택중국의과대학부속성경의원택기행갑상선수술환자90례,안수궤수자표법분위대조조화우미탁미정0.4μg/kg조、0.8μg/lkg조(D0.4조、D0.8조)3조,매조30례.분별우유도삽관후30 min내정맥빙입상응제량우미탁미정혹등량생리염수.기록급약전、수술결속시、정안즉각、발관즉각、발관후10 min적심솔(HR)、수축압(SBP)화서장압(DBP);기록술필지정안시간화발관시간이급술전、술필시호기말이양화탄분압(PETCO2),평개소성조동정도평분(RS)、진정평분(Ramsay)화발관후10 min동통시관모호평분(VAS),이급발관기간불량사건,여창해、악심구토、호흡억제등.결과 ①정안즉각、발관즉각、발관후10 min시,D0.4조화D0.8조HR、SBP화DBP균명현저우대조조;기중D0.8조발관즉각、발관후10 min시HR균저우D0.4조,정안즉각、발관즉각SBP균저우D0.4조,정안즉각DBP명현저우D0.4조.②D0.4조화D0.8조RS평분、VAS평분저우대조조,Ramsay평분고우대조조[RS(분):1.40±0.51、1.20±0.42비1.90±0.56,VAS(분):1.50±0.52、0.80±0.63비2.50±0.52,Ramsay(분):2.10±0.56、2.40±0.51비1.60±0.51,P＜0.05혹P＜0.01];차D0.8조VAS평분명현저우D0.4조(P＜0.01).D0.8조술필지정안시간화발관시간명현장우대조조화D0.4조(min:12.50 ± 1.08비10.50±1.58、10.40±1.26,15.00±0.94비13.00±1.63、12.80±1.13,P＜0.05혹P＜0.01),이대조조여D0.4조지간균무차이.3조환자술전급술필PETCO2비교차이균무통계학의의.③대조조창해반응화악심구토발생솔(16.7％、13.3％)균명현고우D0.4조(3.3％、0)화D0.8조(0、0);3조환자균무호흡억제발생.결론 마취유도후30 min빙입0.4μg/kg우미탁미정가사갑상선수술전마환자소성기HR화혈압경평은,차능축단소성시간화발관시간.
Objective To investigate effects of two doses of dexmedetomidine (Dex) on the recovery quality from general anesthesia undergoing thyroidectomy.Methods A prospective randomized controlled double-blind trial was conducted in 90 patients admitted to Shengjing Hospital of China Medical University who were scheduled for thyroidectomy.They were randomly divided into three groups:group D0.4 received Dex 0.4 μg/kg intravenously,group D0.8 received Dex 0.8 μg/kg intravenously,and control group with same volume of normal saline.There were 30 patients in each group,and all the patients received the above drug or saline 30 minutes after intubation.The heart rate (HR),systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded before Dex administration,at the end of surgery,time of eye opening and extubation,and 10 minutes after extubation.Time of eye opening after surgery and time of extubation after eye opening were recorded.End-tidal partial pressure of carbon dioxide (PETCO2) before and after operation as well as restlessness score (RS),Ramsay sedative score,and visual analogue pain scale (VAS) scores at 10 minutes after extubation were recorded.Events during extubation including cough,nausea and vomiting,respiratory depression were also recorded.Results ① Compared with control group,in D0.4 and D0.8 groups incidence of lowering of HR,SBP and DBP was lower at time of eye opening and extubation,and 10 minutes after extubation.Compared with D0.4 group,D0.8 group had lower HR at the time of extubation and 10 minutes after extubation,SBP was lower at the time of eye opening and extubation,and lower DBP at the time of eye opening.② D0.4 and D0.8 groups showed lower RS and VAS scores than those of control group,Ramsay sedative score in groups D0.4 and D0.8 was higher than that in control group (RS:1.40±0.51,1.20±0.42 vs.1.90±0.56; VAS:1.50±0.52,0.80±0.63 vs.2.50 ± 0.52; Ramsay:2.10 ± 0.56,2.40 ± 0.51 vs.1.60 ± 0.51,P＜0.05 or P＜0.01),and VAS score in group D0.8 was lower than that in D0.4 group (P＜0.01).The time of eye opening and extubation were longer in group D0.8 as compared with those in control and D0.4 groups (minutes:12.50 ± 1.08 vs.10.50 ± 1.58,10.40 ± 1.26; 15.00 ± 0.94 vs.13.00 ± 1.63,12.80 ± 1.13,P＜0.05 or P＜0.01),but there was no significant difference between the latter two groups.No significant difference in PETCO2 was found among three groups before and after surgery.③ The incidence rate of cough,nausea and vomiting in control group (16.7％,13.3％) were significantly higher than those in groups D0.4 (3.3％,0) and D0.8 (0,0).There was no respiratory depression in the three groups.Conclusion Adjunctive infusion of Dex 0.4 μg/kg at 30 minutes after anesthesia induction was recommended as it may result in more steady hemodynamics,with shorter recovery time and extubation time after thyroidectomy.
