CAJ | 학술논문

目的：：观察术前应用右美托咪定联合达克罗宁胶浆预防腹腔镜胆囊切除术苏醒期的躁动,评价其安全性和有效性。方法：将择期行全麻腹腔镜胆囊手术患者80例随机分为对照组(Ⅰ组)、达克罗宁组(Ⅱ组)、右美托咪定组(Ⅲ组)和右美托咪定联合达克罗宁组(Ⅳ组),各20例,患者均不用术前药。Ⅲ、Ⅳ组在诱导前给予右美托咪定0.6μg·kg-1·h-1负荷剂量静脉泵注,15 min后以0.2~0.3μg ·kg-1·h-1的剂量持续泵入,Ⅱ、Ⅳ组达克罗宁胶浆于插管前均匀涂抹气管导管头端至15 cm处,Ⅰ、Ⅱ组泵入等容量0.9%氯化钠注射液,分别于术毕时(T1)、气管导管拔管时(T2)、气管导管拔除后5 min(T3)记录平均动脉压( MAP)和心率( HR),记录苏醒时间、拔管时间以及拔管前Riker镇静躁动评分、拔管后5 min的Ramsay镇静评分。结果：Ⅰ组和Ⅱ组患者T2、T3时MAP均明显高于T1,HR均明显快于T1(P<0.01)；Ⅲ组和Ⅳ组患者T1~T3时MAP均低于Ⅰ组(P<0.05~P<0.01),HR均明显慢于Ⅰ组(P<0.01)。4组苏醒期时间和拔管时间均无明显不同(P>0.05)。Ⅳ组患者Ramsay镇静评分均明显高于Ⅰ、Ⅱ、Ⅲ组(P<0.01)；Ⅱ、Ⅲ和Ⅳ组Riker镇静躁动评分均明显低于Ⅰ组(P<0.01),Ⅲ组和Ⅳ组患者躁动发生率明显低于Ⅰ组(P<0.05)。结论：插管前输注负荷剂量右美托咪定0.6μg·kg-1·h-1,15 min后以0.2~0.3μg ·kg-1·h-1的剂量持续泵入,联合达克罗宁胶浆能有效降低腹腔镜胆囊切除患者苏醒期躁动,并能降低患者拔管期心血管反应,且不延长患者苏醒时间和拔管时间。
목적：：관찰술전응용우미탁미정연합체극라저효장예방복강경담낭절제술소성기적조동,평개기안전성화유효성。방법：장택기행전마복강경담낭수술환자80례수궤분위대조조(Ⅰ조)、체극라저조(Ⅱ조)、우미탁미정조(Ⅲ조)화우미탁미정연합체극라저조(Ⅳ조),각20례,환자균불용술전약。Ⅲ、Ⅳ조재유도전급여우미탁미정0.6μg·kg-1·h-1부하제량정맥빙주,15 min후이0.2~0.3μg ·kg-1·h-1적제량지속빙입,Ⅱ、Ⅳ조체극라저효장우삽관전균균도말기관도관두단지15 cm처,Ⅰ、Ⅱ조빙입등용량0.9%록화납주사액,분별우술필시(T1)、기관도관발관시(T2)、기관도관발제후5 min(T3)기록평균동맥압( MAP)화심솔( HR),기록소성시간、발관시간이급발관전Riker진정조동평분、발관후5 min적Ramsay진정평분。결과：Ⅰ조화Ⅱ조환자T2、T3시MAP균명현고우T1,HR균명현쾌우T1(P<0.01)；Ⅲ조화Ⅳ조환자T1~T3시MAP균저우Ⅰ조(P<0.05~P<0.01),HR균명현만우Ⅰ조(P<0.01)。4조소성기시간화발관시간균무명현불동(P>0.05)。Ⅳ조환자Ramsay진정평분균명현고우Ⅰ、Ⅱ、Ⅲ조(P<0.01)；Ⅱ、Ⅲ화Ⅳ조Riker진정조동평분균명현저우Ⅰ조(P<0.01),Ⅲ조화Ⅳ조환자조동발생솔명현저우Ⅰ조(P<0.05)。결론：삽관전수주부하제량우미탁미정0.6μg·kg-1·h-1,15 min후이0.2~0.3μg ·kg-1·h-1적제량지속빙입,연합체극라저효장능유효강저복강경담낭절제환자소성기조동,병능강저환자발관기심혈관반응,차불연장환자소성시간화발관시간。
Objective:To evaluate the safety and efficacy of dexmedetomidine combined with dyclonine hydrochloride mucilage before general anesthesia in preventing agitation during the recovery period of laparoscopic cholecystectomy. Methods:Eighty patients treated with electively laparoscopic cholecystectomy were randomly divided into the normal saline group ( group Ⅰ) , dyclonine group ( groupⅡ) ,dexmedetomidine group( groupⅢ) and dexmedetomidine combined with dyclonine group( groupⅣ) . The premedication didn't be used in all patients. Group Ⅲ and Ⅳ were treated with a loading dose of dexmedetomidine(0. 6 μg·kg-1 ·h-1 ) by intravenous infusion before anesthesia induction. After 15 min,the dose of dexmedetomidine revised by 0. 2 to 0. 3 μg·kg-1 ·h-1 . The position between the top of the tracheal tube and 15 cm was evenly covered by dyclonine hydrochloride mucilage in groupⅡ andⅣ,groupⅠand Ⅱ were injected with saline infusion. The mean arterial pressure(MAP) and heart rate(HR) in all groups were recorded after operation( T1 ) ,tracheal extubation ( T2 ) and 5 min after extubation ( T3 ) . The time of recovery and extubation, Riker sedation score before extubation and Ramsay sedation score after 5 min of extubation in four groups were observed. Results:Compared with the T1 ,the MAP and HR in groupⅠand groupⅡwere significantly higher at T2 and T3(P<0. 01). The MAP and HR in groupⅢand groupⅣwere lower than those in group Ⅰ at T1 and T3(P<0. 05 to P<0. 01). The differences of the recovery and extubation time in four groups were not statistically different(P>0. 05). The Ramsay sedation score in group Ⅳ was significantly higher than that in other three groups(P<0. 01). The Riker sedation-agitation scores in group Ⅱ,Ⅲ and Ⅳ were significantly lower than those in group Ⅰ(P<0. 01). The incidence of agitation in groupⅢandⅣwere significantly lower than that in groupⅠ(P<0. 05). Conclusions:The treatment of a loading dose of dexmedetomidine(0. 6 μg·kg-1 ·h-1 ) and 0. 2 to 0. 3 μg·kg-1 ·h-1 after 15 min before extubation combined with dyclonine hydrochloride mucilage can effectively prevent agitation of laparoscopic cholecystectomy patients during <br> recovery period, reduce cardiovascular reaction during extubation and not prolong the recovery and extubation time.