CAJ | 학술논문

目的探讨小剂量右美托咪定(Dex)对高血压全麻患者苏醒质量和心血管反应的影响.方法 80例ASA Ⅰ或Ⅱ级拟行腹腔镜胆囊切除术高血压患者,随机分为Dex组(D组)和对照组(C组),每组40例.D组于麻醉诱导前15 min给予Dex负荷剂量0.6μg/kg,术中以小剂量0.3μg/(kg·h)维持静脉泵注至手术结束前30 min,C组则静脉泵注相同剂量的生理盐水.记录两组患者呼吸恢复时间、拔管时间、定向力恢复时间、Ramsay镇静评分、VAS镇痛评分和不良反应发生率及拔管前(T0)、拔管时(T1)、拔管后5min(T2)、15 min(T3)、30 min(T4)BP、HR和SpO2的变化.结果两组患者的呼吸恢复时间、拔管时间、定向力恢复时间比较差异无统计学意义(P＞0.05),D组拔管后各时点Ramsay镇静评分高于C组、VAS镇痛评分低于C组,比较差异有统计学意义(P＜0.05),与C组比较,D组拔管期不良反应明显减少(P＜0.05),心血管反应明显减轻(P＜0.05);与拔管前比较,C组拔管时、拔管后血压明显升高(P＜0.05).结论小剂量右美托咪定可有效地改善高血压患者全麻拔管期苏醒质量,并明显减轻心血管反应.
목적 탐토소제량우미탁미정(Dex)대고혈압전마환자소성질량화심혈관반응적영향.방법 80례ASA Ⅰ혹Ⅱ급의행복강경담낭절제술고혈압환자,수궤분위Dex조(D조)화대조조(C조),매조40례.D조우마취유도전15 min급여Dex부하제량0.6μg/kg,술중이소제량0.3μg/(kg·h)유지정맥빙주지수술결속전30 min,C조칙정맥빙주상동제량적생리염수.기록량조환자호흡회복시간、발관시간、정향력회복시간、Ramsay진정평분、VAS진통평분화불량반응발생솔급발관전(T0)、발관시(T1)、발관후5min(T2)、15 min(T3)、30 min(T4)BP、HR화SpO2적변화.결과 량조환자적호흡회복시간、발관시간、정향력회복시간비교차이무통계학의의(P＞0.05),D조발관후각시점Ramsay진정평분고우C조、VAS진통평분저우C조,비교차이유통계학의의(P＜0.05),여C조비교,D조발관기불량반응명현감소(P＜0.05),심혈관반응명현감경(P＜0.05);여발관전비교,C조발관시、발관후혈압명현승고(P＜0.05).결론 소제량우미탁미정가유효지개선고혈압환자전마발관기소성질량,병명현감경심혈관반응.
Objectives To investigate the influence of low doses dexmedetomidine on the quality of cognitive recovery and cardiovascular response in hypertensive patients during extubation after general anesthesia.Methods 80 hypertensive patients (ASA Ⅰ-Ⅱ) scheduled for laparoscopic cholecystectomy were randomly divided into a Dex group (group D) and a control group(group C),40 for each group.Group D were given dexmedetomidine with a loading dose of 0.6 μ g/kg 15 min before the induction intravenously and maintained the operation with a low dose of 0.3 μ g/(kg · h) until 30 min before the end of the operation.Group C were given saline of the same dose intravenously.The breathing recovery time,the extubation time,the cognitive recovery time,the Ramsay sedation score,the Visual Analogue Scale,and the incidence of adverse reactions (cough,restlessness,chills,nausea and vomiting,dizziness and headache,etc.) of both groups were recorded; the changes of hemodynamic parameters such as arterial blood pressure (BP),heart rate (HR),and pulse oxygen saturation (SpO2) of all the patients 30 mins before extubation (T0),at extubation (T1),5 mins after extubation (T2),15 mins after extubation (T3),and 30 mins after extubation (T4) were monitored.Results There were no statistical differences in breathing recovery time,extubation time,and cognitive recovery time between these two groups (P ＞ 0.05).compared with Group C,The Ramsay sedation score was higher,the Visual Analogue Scale and the incidence of adverse reactions were lower,and the cardiovascular responses were significantly fewer in group D than in group C (P ＜ 0.05).The arterial blood pressure(BP) were significantly higher at T1,T2,T3,and T4 than at T0 in group C (P ＜ 0.05).Conclusions Low doses of dexmedetomidine can effectively improve the quality of cognitive recovery in hypertensive patients during extubation after general anesthesia and significantly attenuate the cardiovascular response.