CAJ | 학술논문

目的：探讨右美托咪定对全麻下行颅骨缺损修补术患者术后苏醒的影响。方法：选取本院2008年2月-2013年11月收治的63例ASA分级Ⅰ~Ⅱ级行择期颅骨修补术的患者作为研究对象，将其随机分为D1组（右美托咪定用量为0.5μg/kg）、D2组（右美托咪定用量为1.0μg/kg）和C组（生理盐水对照组）。所有患者全麻诱导与维持方法相同。记录拔除气管导管时（T1）、拔除气管导管后5 min（T2）、10 min（T3）、30 min（T4）各个时点的躁动评分（RS）。记录手术时间、拔管时间（从给右美托咪定或生理盐水至拔除气管导管时间）、离室时间（从拔除气管导管至离开手术室的时间）和苏醒过程中的呛咳、恶心、呕吐和心血管不良事件发生情况。结果：三组患者的拔管时间、离室时间和手术时间比较差异均无统计学意义（P>0.05）；T1、T2、T3、T4各时点，D1组和D2组的RS均明显低于C组，差异均有统计学意义（P<0.05）；D1组的RS与D2组比较，差异均无统计学意义（P>0.05）。D1组和D2组的呛咳发生率均明显低于C组（P<0.05），D1组的心血管不良事件发生率均明显低于D2组和C组，差异均有统计学意义（P<0.05）。结论：缝皮时，静脉泵注右美托咪定0.5μg/kg，提高了颅骨修补术患者术后苏醒质量，更为安全有效。
목적：탐토우미탁미정대전마하행로골결손수보술환자술후소성적영향。방법：선취본원2008년2월-2013년11월수치적63례ASA분급Ⅰ~Ⅱ급행택기로골수보술적환자작위연구대상，장기수궤분위D1조（우미탁미정용량위0.5μg/kg）、D2조（우미탁미정용량위1.0μg/kg）화C조（생리염수대조조）。소유환자전마유도여유지방법상동。기록발제기관도관시（T1）、발제기관도관후5 min（T2）、10 min（T3）、30 min（T4）각개시점적조동평분（RS）。기록수술시간、발관시간（종급우미탁미정혹생리염수지발제기관도관시간）、리실시간（종발제기관도관지리개수술실적시간）화소성과정중적창해、악심、구토화심혈관불량사건발생정황。결과：삼조환자적발관시간、리실시간화수술시간비교차이균무통계학의의（P>0.05）；T1、T2、T3、T4각시점，D1조화D2조적RS균명현저우C조，차이균유통계학의의（P<0.05）；D1조적RS여D2조비교，차이균무통계학의의（P>0.05）。D1조화D2조적창해발생솔균명현저우C조（P<0.05），D1조적심혈관불량사건발생솔균명현저우D2조화C조，차이균유통계학의의（P<0.05）。결론：봉피시，정맥빙주우미탁미정0.5μg/kg，제고료로골수보술환자술후소성질량，경위안전유효。
Objective:To investigate the effects of Dexmedetomidine on the postoperative recovery of patients with cranioplasty under general anesthesia.Method:Sixty-three ASA Ⅰ or Ⅱ patients with cranioplasty admitted to our hospital from February 2008 to November 2013 were selected as research objects,they were randomly divided into the group D1 (Dexmedetomidine dosage was 0.5 g/kg),the group D2(Dexmedetomidine dosage was 1.0 g/kg) and the group C(the normal saline control group),21 cases in each group.The same induction and maintenance of general anesthesia were used in each group. At the time of suturing scalp,Dexmedetomidine 0.5 μg/kg and 1.0 μg/kg were infused by micropump within ten minutes in group D1 and group D2 respectively,while the equal volume of 0.9% normal saline was administered instead of Dexmedetomidine in group C.Restlessness scores(RS) were assessed and recorded at immediately(T1) and 5,10,30 minutes(T2,T3,T4 respectively) after extubation.The operation time,extubation time(from infusion of Dexmedetomidine or normal saline to tracheal extubation),the time of leaving the operating room(from tracheal extubation to leaving the operating room) were recorded. The incidence of the nausea,vomiting,reflective coughing and adverse cardiovascular events were recorded in the process of awakening.Result:There were no statistically significant differences in the extubation time,the time of leaving the operating room and operation time among the three groups(P>0.05).At time point of T1,T2,T3,T4,the RS of the group D1 and the group D2 were significantly lower than the group C,the differences were statistically significant(P<0.05),otherwise there was no statistically significant difference in RS between group D2 and group D1 meanwhile(P>0.05).The incidence of reflective coughing in the group D1 and the group D2 were significantly lower than the group C,and the incidence of adverse cardiovascular events in the group D1 was significantly lower than the group D2 and the group C,the differences were statistically significant (P<0.05).Conclusion:When suturing scalp,infusion of Dexmedetomidine 0.5 μg/kg can improve the quality of postoperative recovery of patients with cranioplasty and is more effective and safer.