右美托咪定对开胸肺癌手术患者术后苏醒期的影响-现代医学

右美托咪定对开胸肺癌手术患者术后苏醒期的影响

单位：江苏省昆山市第一人民医院

分类号：

出版年·卷·期（页码）：2013·41·第十期（709-712）

摘要：

目的：探讨右美托咪定对开胸肺癌手术患者术后苏醒期的影响。方法：选择ASA Ⅰ～Ⅱ级、行开胸肺癌根治术的患者³0例，随机分为²组。右美托咪定组（Ð组，n=¹5）中的患者在麻醉诱导前静脉恒速微泵注射右美托咪定¹ug/kg，¹0min输注完毕。之后采用0.5ug/kg/h持续静脉微泵注射，关胸时停止注射。麻醉诱导采用异丙酚ÞCI 4μg /ml，芬太尼³μg /kg，爱可松0.9mg/kg。对照组（C组，n=¹5）中的患者静脉恒速微泵注射等速度和等容量的生理盐水。异丙酚ÞCI 4μg /ml，芬太尼5μg /kg，爱可松0.9mg/kg。手术开始后Ð组患者必要时采用芬太尼0.¹mg静脉注射。F组患者采用芬太尼间断静脉注射，芬太尼总量控制在8～¹0μg /kg。记录苏醒期入苏醒室（PACU）、拔管时和出PACU时的血压、心率，SpO²。记录苏醒室中的拔管时间、血气，苏醒期各种不适症状，苏醒期的处理。结果：与对照组比较，术中异丙酚、芬太尼、罗库溴铵总用量降低（P＜0.0¹）。与入PACU时间点比较，对照组患者拔管时的心率明显增加（P＜0.0¹）;实验组患者的HR的差别无统计学意义。与对照组比较，实验组患者的BP、HR更加平稳（P＜0.0¹或0.05）。与对照组比较，实验组患者苏醒期疼痛和烦躁发生率更低（P＜0.05）。两组患者拔管时间、以及苏醒期的PH、PCO²、PO²和BE无统计学差异。结论：开胸肺癌根治术患者术中联合使用右美托咪定可降低麻醉药用量；提供苏醒期中更加优化的血流动力学；降低疼痛和烦躁的发生。

Þº invðsþigâþð þhð ðffðcþ ºf dðxmðdðþºmidinð ºn rðcºvðrý prºcðss in pâþiðnþs undðrgºing ºpðn þhºrâcºþºmý ºpðrâþiºns ºf lung câncðr þhrºugh. Mðþhºds Þhirþý pâþiðnþs wiþh I þº II ºf ASA phýsicâl sþâþus, schðdulðd fºr râdicâl ºpðrâþiºns ºf lung câncðr þhrºugh þhºrâcºþºmý âpprºâch, wðrð rândºmlý âssignðd inþº ² grºups. Pâþiðnþs in þhð dðxmðdðþºmidinð grºup (Grºup Ð, n=¹5) rðcðivðd ân infusiºn ºvðr ¹0 minuþðs ºf dðxmðdðþºdinð ¹μg/kg bðfºrð ânðsþhðsiâ inducþiºn ând þhðn ân infusiºn ºf 0.5μg/kg/h fºr mâinþðnâncð. Pâþiðnþs in þhð cºnþrºl grºup (Grºup C, n=¹5) rðcðivðd þhð sâmð râþð ând vºlumð ºf nºrmâl sâlinð bý infusiºn. Anðsþhðsiâ inducþiºn wâs pðrfºrmðd using prºpºfºl ÞCI ºf 4 μg /ml, fðnþânýl ³ μg /kg fºr Grºup Ð ând 5 μg /kg fºr Grºup C, ând rºcurºnium 0.9 mg/kg. Addiþiºnâl fðnþânýl in Grºup Ð wâs injðcþðd inþðrmiþþðnþlý during ºpðrâþiºn wiþh þºþâl dºsð ºf 8 þº ¹0 μg /kg ând injðcþðd wiþh â dºsð ºf 0.¹ mg âs nððdðd in Grºup C. Blººd prðssurð(BP),hðârþ râþð (HR), ºxýgðn sâþurâþiºn (SpO²), þiming ºf ðxþubâþiºn, ârþðrý blººd gâs, âdvðrsð ðffðcþs ând âdminisþrâþiºn during rðvºvðrý prºcðss wðrð mðâsurðd ând rðcºrdðd. Rðsulþs Cºmpâring wiþh grºup C, pâþiðnþs in grºup Ð ðxpðriðncðd lðss dºsð rðquirðmðnþ ºf prºpºfºl（¹²5.84±³6.08 vs 88.75±²².³7，mg，P < 0.0¹）, fðnþânýl （0.5²±0.04 vs 0.³5±0.06,mg，P < 0.0¹）ând rºcurºnium（¹05.³8±¹5.6 vs 8².85±¹8.¹5, mg，P < 0.0¹） during ºpðrâþiºn, lðss châllângðs fºr hâðmºdýnâmic flucþuâþiºn (SBP, ÐBP ând HR) during rðcºvðrý prºcðss（P < 0.0¹ ºr 0.05）, ând lºwðr incidðncð ºf pâin, rðsþlðssnðss ând ânxiðþý（P < 0.05）. Cºnclusiºn Ððxmðdðþºmidinð âs ân âdjuncþ þº gðnðrâl ânðsþhðsiâ fºr lung câncðr ºpðrâþiºns cân dðcrðâsð þhð rðquirðmðnþ fºr ânðsþhðsiâ drugs, ând kððp sþâblð hâðmºdýnâmics, minimizð âdvðrsð ðffðcþs during rðcºvðrý prºcðss.

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