中华口腔医学研究杂志(电子版)
中華口腔醫學研究雜誌(電子版)
중화구강의학연구잡지(전자판)
CHINESE JOURNAL OF STOMATOLOGICAL RESEARCH(ELECTRONIC VERSION)
2014年
5期
408-413
,共6页
徐晓莹%傅钢兰%赵小朋%何波%潘朝斌
徐曉瑩%傅鋼蘭%趙小朋%何波%潘朝斌
서효형%부강란%조소붕%하파%반조빈
右美托咪定%利多卡因乳膏%全麻苏醒期%气管切开%镇静%镇痛
右美託咪定%利多卡因乳膏%全痳囌醒期%氣管切開%鎮靜%鎮痛
우미탁미정%리다잡인유고%전마소성기%기관절개%진정%진통
Dexmedetomidine%Lidocaine cream%General anesthesia recovery period%Tracheotomy%Sedation%Analgesia
目的探讨右美托咪定联合复方利多卡因乳膏对口腔颌面部肿瘤手术患者术后气管切开的镇静和镇痛效果。方法将口腔颌面部肿瘤术后需要气管切开的60例患者随机分为右美托咪定联合利多卡因乳膏组(R组,20例)、右美托咪定组(D组,20例)、0.9%氯化钠溶液组(N组,20例)。在开始缝合切口时(约术毕前1 h),R组和D组分别用30 min输注右美托咪定0.5μg/kg, N组以同样的时间输注同等剂量的0.9%氯化钠溶液。在术毕气管切开更换气管套管时,R组在气管套管外壁涂抹利多卡因乳膏。比较三组患者的苏醒时间、苏醒期间呛咳、躁动的情况以及心率(HR)、血压(BP)和呼吸(RR)的变化。采用SPSS 17.0软件包对数据进行统计学处理。结果(1)三组苏醒时间差异无统计学意义(P=0.266);(2)苏醒期R组追加芬太尼的次数和追加芬太尼后血氧饱和度(SpO2)下降至90%以下的例数均明显少于D组和N组(D组:χ2=7.619,P=0.006,χ2=8.547, P=0.003;N组:χ2=25.600,P<0.05,χ2=24.000,P<0.05),D组少于N组(χ2=7.619,P=0.006;χ2=6.995, P=0.008);(2)苏醒时呛咳评分R组明显低于D组和N组(D组:P=0.006;N组:P<0.05),D组明显低于N组(P=0.007),追加芬太尼后D组和N组呛咳评分明显下降,苏醒30 min至1 h又再度上升,而R组的呛咳评分在苏醒期各时间点都较低且无明显波动(F=0.716,P=0.702);(3)苏醒期Rass评分显示R组一直处于平稳的最佳镇静状态(F=0.886,P=0.662),而D组和N组的镇静程度不佳,在追加芬太尼前后呈现由烦躁到镇静过度的转变,其中N组最为明显(D组:F=4.335,P=0.017;N组:F=20.476,P<0.05);(4)麻醉诱导前与苏醒期R组HR、BP及RR的变化均不明显(HR:F=1.876,P=0.225;MAP:F=1.520,P=0.301;RR:F=1.112,P=0.465),D组和N组的波动比较明显,其中N组波动最明显(D组HR:F=3.472,P=0.041;MAP:F=3.465,P=0.042;RR:F=3.982,P=0.032;N组HR:F=5.674, P=0.005;MAP:F=5.442,P=0.006;RR:F=15.232,P<0.05)。结论右美托咪定静脉注射联合利多卡因乳膏涂抹气管套管用于术毕气管切开的患者,能明显减少全麻苏醒期患者的呛咳和躁动,使苏醒期血流动力学平稳,且不延长苏醒时间。
目的探討右美託咪定聯閤複方利多卡因乳膏對口腔頜麵部腫瘤手術患者術後氣管切開的鎮靜和鎮痛效果。方法將口腔頜麵部腫瘤術後需要氣管切開的60例患者隨機分為右美託咪定聯閤利多卡因乳膏組(R組,20例)、右美託咪定組(D組,20例)、0.9%氯化鈉溶液組(N組,20例)。在開始縫閤切口時(約術畢前1 h),R組和D組分彆用30 min輸註右美託咪定0.5μg/kg, N組以同樣的時間輸註同等劑量的0.9%氯化鈉溶液。在術畢氣管切開更換氣管套管時,R組在氣管套管外壁塗抹利多卡因乳膏。比較三組患者的囌醒時間、囌醒期間嗆咳、躁動的情況以及心率(HR)、血壓(BP)和呼吸(RR)的變化。採用SPSS 17.0軟件包對數據進行統計學處理。結果(1)三組囌醒時間差異無統計學意義(P=0.266);(2)囌醒期R組追加芬太尼的次數和追加芬太尼後血氧飽和度(SpO2)下降至90%以下的例數均明顯少于D組和N組(D組:χ2=7.619,P=0.006,χ2=8.547, P=0.003;N組:χ2=25.600,P<0.05,χ2=24.000,P<0.05),D組少于N組(χ2=7.619,P=0.006;χ2=6.995, P=0.008);(2)囌醒時嗆咳評分R組明顯低于D組和N組(D組:P=0.006;N組:P<0.05),D組明顯低于N組(P=0.007),追加芬太尼後D組和N組嗆咳評分明顯下降,囌醒30 min至1 h又再度上升,而R組的嗆咳評分在囌醒期各時間點都較低且無明顯波動(F=0.716,P=0.702);(3)囌醒期Rass評分顯示R組一直處于平穩的最佳鎮靜狀態(F=0.886,P=0.662),而D組和N組的鎮靜程度不佳,在追加芬太尼前後呈現由煩躁到鎮靜過度的轉變,其中N組最為明顯(D組:F=4.335,P=0.017;N組:F=20.476,P<0.05);(4)痳醉誘導前與囌醒期R組HR、BP及RR的變化均不明顯(HR:F=1.876,P=0.225;MAP:F=1.520,P=0.301;RR:F=1.112,P=0.465),D組和N組的波動比較明顯,其中N組波動最明顯(D組HR:F=3.472,P=0.041;MAP:F=3.465,P=0.042;RR:F=3.982,P=0.032;N組HR:F=5.674, P=0.005;MAP:F=5.442,P=0.006;RR:F=15.232,P<0.05)。結論右美託咪定靜脈註射聯閤利多卡因乳膏塗抹氣管套管用于術畢氣管切開的患者,能明顯減少全痳囌醒期患者的嗆咳和躁動,使囌醒期血流動力學平穩,且不延長囌醒時間。
목적탐토우미탁미정연합복방리다잡인유고대구강합면부종류수술환자술후기관절개적진정화진통효과。방법장구강합면부종류술후수요기관절개적60례환자수궤분위우미탁미정연합리다잡인유고조(R조,20례)、우미탁미정조(D조,20례)、0.9%록화납용액조(N조,20례)。재개시봉합절구시(약술필전1 h),R조화D조분별용30 min수주우미탁미정0.5μg/kg, N조이동양적시간수주동등제량적0.9%록화납용액。재술필기관절개경환기관투관시,R조재기관투관외벽도말리다잡인유고。비교삼조환자적소성시간、소성기간창해、조동적정황이급심솔(HR)、혈압(BP)화호흡(RR)적변화。채용SPSS 17.0연건포대수거진행통계학처리。결과(1)삼조소성시간차이무통계학의의(P=0.266);(2)소성기R조추가분태니적차수화추가분태니후혈양포화도(SpO2)하강지90%이하적례수균명현소우D조화N조(D조:χ2=7.619,P=0.006,χ2=8.547, P=0.003;N조:χ2=25.600,P<0.05,χ2=24.000,P<0.05),D조소우N조(χ2=7.619,P=0.006;χ2=6.995, P=0.008);(2)소성시창해평분R조명현저우D조화N조(D조:P=0.006;N조:P<0.05),D조명현저우N조(P=0.007),추가분태니후D조화N조창해평분명현하강,소성30 min지1 h우재도상승,이R조적창해평분재소성기각시간점도교저차무명현파동(F=0.716,P=0.702);(3)소성기Rass평분현시R조일직처우평은적최가진정상태(F=0.886,P=0.662),이D조화N조적진정정도불가,재추가분태니전후정현유번조도진정과도적전변,기중N조최위명현(D조:F=4.335,P=0.017;N조:F=20.476,P<0.05);(4)마취유도전여소성기R조HR、BP급RR적변화균불명현(HR:F=1.876,P=0.225;MAP:F=1.520,P=0.301;RR:F=1.112,P=0.465),D조화N조적파동비교명현,기중N조파동최명현(D조HR:F=3.472,P=0.041;MAP:F=3.465,P=0.042;RR:F=3.982,P=0.032;N조HR:F=5.674, P=0.005;MAP:F=5.442,P=0.006;RR:F=15.232,P<0.05)。결론우미탁미정정맥주사연합리다잡인유고도말기관투관용우술필기관절개적환자,능명현감소전마소성기환자적창해화조동,사소성기혈류동역학평은,차불연장소성시간。
Objective To explore the sedative and analgesic effect of combining dexmedetomidine with lidocaine cream during recovery period after tracheotomy in oral and maxillofacial tumor surgery. Methods Sixty patients who needed to get tracheotomy after oral and maxillofacia l tumor surgery were randomly divided into three groups. When suturing incision, dexmedetomidine at 0.5 μg/kg in Group R and D, and saline in Group N were administrated intravenously for 30 minutes . When replacing the tracheal tube in tracheotomy, Group R was smeared by lidocaine cream on the surface of the tracheal tube. Coughing, dysphoria, recovery time, MAP, HR and RR were recorded. SPSS 17.0 software package were used for data processing. Results There was no significant difference in recovery time among the three groups (P=0.266). Times of adding fentanyl and cases of SpO2 declining below 90%after adding fentanyl in Group R were obviously fewer than those in Group D and Group N (Group D:χ2=7.619,P=0.006,χ2=8.547,P=0.003;Group N:χ2=25.600,P<0.05,χ2=24.000,P<0.05), while those in Group D were also obviously fewer than those in Group N (χ2=7.619,P=0.006;χ2=6.995,P= 0.008). During recovery time, there were no significant changes of Rass score, coughing score, HR, MAP or RR in Group R (P>0.05), while those in Group D and Group N changed a lot along with adding fentanyl (P<0.05), especially in Group N (P<0.05). Conclusion Dexmedetomidine combining with lidocaine cream is effective in attenuating coughing , dysphoria and hemodynamic changes during recover period for patients undergoing tracheotomy after oral and maxillofacial tumor surgery . Besides, it do not extend the recovery period.