右美托咪定对颅内动脉瘤患者围拔管期应激反应和苏醒质量的影响

中国临床药理学与治疗学 ›› 2013, Vol. 18 ›› Issue (10): 1144-1147.

右美托咪定对颅内动脉瘤患者围拔管期应激反应和苏醒质量的影响

章玲宾¹, 樊理华¹, 卢向红¹, 何仁洪¹, 陈琴¹, 游敏吉¹, 徐巧敏¹, 丁友法²

¹浙江省丽水市人民医院(温州医学院附属第六医院)麻醉科,
²检验科,丽水 323000,浙江

收稿日期:2012-12-27 修回日期:2013-06-21 出版日期:2013-10-26 发布日期:2013-09-30
作者简介:章玲宾,男,主治医师,研究方向:围术期重要脏器的功能保护和应激反应的预防。Tel: 18957090895 E-mail: lszhanglingbin@126.com
基金资助:
浙江省丽水市重点建设学科科技项目(丽科[2010]57-13)

Effects of dexmedetomidine to intracranial aneurysms with stress response and awakening quality on tracheal extubation

ZHANG Ling-bin¹, FAN Li-hua¹, LU Xiang-hong¹, HE Ren-hong¹, CHEN Qin¹, YOU Min-ji¹, XU Qiao-min¹, DING You-fa²

¹Department of Anesthesiology,
²Clinical Laboratory, Lishui People's Hospital of Zhejiang (the Sixth Affiliated HosPital of Wenzhou Medical College), Lishui 323000,Zhejiang,China

Received:2012-12-27 Revised:2013-06-21 Online:2013-10-26 Published:2013-09-30

摘要/Abstract

摘要： 目的:观察右美托咪定(Dexmedetomidine,Dex)对颅内动脉瘤患者围拔管期应激反应和苏醒质量的影响。方法:选择Hunt/ Hess分级为I～II 级的施行颅内动脉瘤夹闭术患者50 例。随机分成右美托咪定(A组)和生理盐水对照组 (B组) ,每组25例。A组麻醉前 10 min 微泵静脉注射右美托咪定 0.5 μg/kg,术中 0.4 μg·kg^-1·h^-1持续泵注,B组给予等容量的0.9%的氯化钠注射液。两组均采用静吸复合全麻。记录入手术室时(T₁)、拔管即刻(T₂)、拔管后 5 min(T₃)、10 min(T₄) 的血压(BP)、心率(HR)变化,抽外周静脉血测定皮质醇(COR)、血糖(GLU)、血乳酸(LAC)浓度, 并记录麻醉恢复时间,苏醒期躁动评分、拔管后 30 min 视觉模拟(VAS)镇痛评分和Ramsay镇静程度评分。结果:B组的MAP、HR、COR、GLU、LAC较A组增高更为明显(P<0.01 或P<0.05);B组苏醒期躁动评分和拔管后 30 min VAS评分高于A组,而Ramsay镇静程度评分低于A组(P<0.05)。结论:右美托咪定有效抑制了围拔管期的应激反应,能提高麻醉苏醒质量,不延迟苏醒时间。

关键词: 颅内动脉瘤, 围拔管期, 应激反应, 苏醒质量, 右美托咪定

Abstract: AIM: To observe the effect of dexmedetomidine on intracranial aneurysms with stress response and awakening quality on tracheal extubation.METHODS: Select Hunt / Hess grading as I-II-class implementation of intracranial aneurysm surgery patients 50 cases, and randomly divided into dexmedetomidine group (group A) and normal saline group (group B), 25 patients in each. Group A were given dexmedetomidine with 0.5 μg/kg continuous infusion for 10 min before anesthesia, intraoperative 0.4 μg·kg^-1·h^-1 continuous infusion. Group B were given the same dose of 0.9% sodium chloride injection. Both groups were treated with combined intravenous-inhalation anesthesia. We recorded the changes of blood pressure (BP) and heart rate (HR) at into the operating room (T₁),extubation (T₂), extubation after 5 min (T₃), 10 min (T₄),measured the concentration of cortisol (COR), blood glucose (GLU), blood lactate (LAC), and recorded anesthesia recovery time,restlessness rating,visual analogue pain scores (VAS) and Ramsay sedation scores after extubation 30 min.RESULTS: The MBP, HR, COR, GLU, LAC of Group B increased more significantly (P<0.01 or P<0.05) than group A. Group B restlessness score and at VAS score 30 minutes after extubation were higher than those of group A, but Ramsay sedation scores were lower in group A (P<0.05).CONCLUSION: Dexmedetomidine can effectively inhibit the stress response to tracheal extubation period, can improve the quality of recovery from anesthesia, do not delay recovery.

Key words: Intracranial aneurysms, Tracheal extubation period, Stress response, Awakening quality, Dexmedetomidine

中图分类号:

R614

章玲宾, 樊理华, 卢向红, 何仁洪, 陈琴, 游敏吉, 徐巧敏, 丁友法. 右美托咪定对颅内动脉瘤患者围拔管期应激反应和苏醒质量的影响[J]. 中国临床药理学与治疗学, 2013, 18(10): 1144-1147.

ZHANG Ling-bin, FAN Li-hua, LU Xiang-hong, HE Ren-hong, CHEN Qin, YOU Min-ji, XU Qiao-min, DING You-fa. Effects of dexmedetomidine to intracranial aneurysms with stress response and awakening quality on tracheal extubation[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2013, 18(10): 1144-1147.

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