CAJ | 학술논문

目的：比较不同剂量右美托咪啶复合麻醉对阻塞性睡眠呼吸暂停综合征（OSAS）患者悬雍垂腭咽成形术（UPPP）苏醒期的影响。方法选取在全麻下行UPPP的OSAS患者60例，根据随机数字表法分为Ⅰ组、Ⅱ组和Ⅲ组，各20例。Ⅱ组和Ⅲ组在麻醉诱导前先予右美托咪啶0.5μg/kg作为负荷剂量，术中Ⅱ组持续静脉泵注右美托咪啶0.3μg/（kg·h），Ⅲ组术中持续泵注右美托咪啶0.6μg/（kg·h），Ⅰ组持续泵注等容量0.9%氯化钠溶液。观察术前（T0）、拔管即刻（T1）、拔管后10min（T2）HR、MAP、皮质醇浓度变化，记录气管拔管时间、Ramsay镇静评分和拔管期不良反应发生率。结果3组患者气管拔管时间、呼吸抑制、恶心、呕吐发生率比较差异均无统计学意义（均P＞0.05）。3组患者HR、MAP、皮质醇浓度T1、T2较T0明显增加，Ⅰ组在T1、T2时点明显升高（P＜0.01），Ⅱ组和Ⅲ组在T2轻度升高（P＜0.05），在T2升高不明显（P＞0.05）；Ⅱ组和Ⅲ组较Ⅰ组在T1、T2时点HR、MAP、皮质醇浓度均有明显下降（P＜0.05或0.01）；与Ⅱ组相比，Ⅲ组患者在T1HR、MAP、皮质醇浓度明显下降（P＜0.05），但在T2差异不明显（P＞0.05）。与Ⅰ组比较，Ⅱ组和Ⅲ组患者Ramsay镇静评分明显增加（P＜0.05或0.01）；与Ⅱ组相比，Ⅲ组患者Ramsay镇静评分明显增加（P＜0.05）。Ⅱ组和Ⅲ组患者的躁动发生率也低于Ⅰ组（P＜0.01）。结论右美托咪啶0.6μg/（kg·h）对OSAS患者UPPP术后苏醒期能提供安全有效的拔管条件，减少应激反应，而不影响呼吸。
목적：비교불동제량우미탁미정복합마취대조새성수면호흡잠정종합정（OSAS）환자현옹수악인성형술（UPPP）소성기적영향。방법선취재전마하행UPPP적OSAS환자60례，근거수궤수자표법분위Ⅰ조、Ⅱ조화Ⅲ조，각20례。Ⅱ조화Ⅲ조재마취유도전선여우미탁미정0.5μg/kg작위부하제량，술중Ⅱ조지속정맥빙주우미탁미정0.3μg/（kg·h），Ⅲ조술중지속빙주우미탁미정0.6μg/（kg·h），Ⅰ조지속빙주등용량0.9%록화납용액。관찰술전（T0）、발관즉각（T1）、발관후10min（T2）HR、MAP、피질순농도변화，기록기관발관시간、Ramsay진정평분화발관기불량반응발생솔。결과3조환자기관발관시간、호흡억제、악심、구토발생솔비교차이균무통계학의의（균P＞0.05）。3조환자HR、MAP、피질순농도T1、T2교T0명현증가，Ⅰ조재T1、T2시점명현승고（P＜0.01），Ⅱ조화Ⅲ조재T2경도승고（P＜0.05），재T2승고불명현（P＞0.05）；Ⅱ조화Ⅲ조교Ⅰ조재T1、T2시점HR、MAP、피질순농도균유명현하강（P＜0.05혹0.01）；여Ⅱ조상비，Ⅲ조환자재T1HR、MAP、피질순농도명현하강（P＜0.05），단재T2차이불명현（P＞0.05）。여Ⅰ조비교，Ⅱ조화Ⅲ조환자Ramsay진정평분명현증가（P＜0.05혹0.01）；여Ⅱ조상비，Ⅲ조환자Ramsay진정평분명현증가（P＜0.05）。Ⅱ조화Ⅲ조환자적조동발생솔야저우Ⅰ조（P＜0.01）。결론우미탁미정0.6μg/（kg·h）대OSAS환자UPPP술후소성기능제공안전유효적발관조건，감소응격반응，이불영향호흡。
Objective To evaluate the effects of different doses of dexmedetomidine on recovery of anesthesia in patients with obstructive sleep apnea syndrome (OSAS) undergoing uvulopalatopharyngoplasty (UPPP). Methods Sixty OSAS patients scheduled for elective UPPP were randomly divided into three groups with 20 in each: in group I, NS was given as control; in group II and III, a load dose of 0.5μg/kg dexmedetomidine was given fol owed by infusion of 0.3μg/kg·h-1 or 0.6μg/kg·h-1 dexmedetomidine respectively. Combined anesthesia was maintained with sevoflurane, propofol and remifentanyl to keep the BIS values between 35 and 55. Heat rate(HR), mean arterial blood pressure (MAP) and serum concentration of cortisol were measured before surgery(T0), on extubation(T1) and 10 min after extubation(T2). The extubation time after anesthesia withdrawal and the oc-currence of emergence agitation were documented. The incidences of respiratory depression and post- operation nausea and vomiting (PONV) and Ramsay sedative scores after extubation were also recorded. Results In the group I, HR, MAP and the serum concentration of cortisol at T0 were significantly lower than those at T1 and T2 (P<0.01), while in the group II and group III, HR, MAP and the serum concentration of cortisol at T1 were significantly higher than those at T0 (P<0.05), but they returned to baseline and there were no differences between T2 and T0. There were significant differences in these three indexes at T1 among 3 groups;there were significant differences at T2 between groups I and II, but no difference between groups II and III. There were also significant differences in Ramsay sedative scores among 3 groups (P<0.05). The incidence of emergence agitation in group I was significantly higher than that in groups II and III (P<0.01). There were no differences in extubation time, incidence of respi-ratory depression and PONV among three groups. Conclusion Continuous infusion of 0.6μg/kg·h-1 dexmedetomidine during the combined anesthesia in OSAS patients undergoing UPPP can attenuate stress response, not affect respiration and result in efficient extubation and a safe and comfortable awaking period.