右美托咪定对开胸手术患者苏醒期躁动的影响(1)
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[摘要] 目的 探讨静脉输注右美托咪定对开胸手术患者麻醉苏醒期躁动的影响。 方法 选择ASA I或Ⅱ级择期行开胸手术的患者40例，分为右美托咪定组(A组)和生理盐水对照组(B组)。A组患者在麻醉诱导前给予右美托咪定负荷剂量0.8 μg /kg (给药时间>10 min)及0.4 μg/(kg·h)的维持量。B组以同等方法泵入生理盐水。术中采用多功能脑电监测仪(BIS)，了解麻醉深度。观察患者苏醒期躁动情况。 结果 苏醒期各个时点A组心率、血压增高的程度均低于B组(P < 0.05)。躁动例数A组较B组少(P < 0.05)。 结论 右美托咪定可使全麻开胸手术患者苏醒期的血流动力学更稳定，躁动减少。
[关键词] 麻醉；右美托咪定；躁动；开胸手术
[中图分类号] R614.1 [文献标识码] B [文章编号] 1673-9701(2012)06-0087-03
Using of dexmedetomidine for prevention of agitation in patients undergoing thoracotomy
WEI Zhanhong LV Huayan DU Guangsheng
Department of Anesthesiology，Jinhua Central Hospital in Zhejiang Province，Jinhua 321000，China
[Abstract] Objective To investigate the use of dexmedetomidine for prevention of agitation on patients undergoing thoracotomy. Methods Forty ASA I-II patients undergoing thoracotomy were enrolled in this study. The patients were randomly divided into two groups (Group A and Group B). Group A: Just 10 min before general anesthesia induction, the patients were injected with dexmedetomedine at the rate of 0.8 μg/kg as a load dosage. Followed by the rate of 0.4 μg/(kg·h) as the maintenance dose after intubation. Group B: Normal saline was given at the same rate in the correspondingly periods of time. BIS was used for anesthesia depth monitoring during surgery. Emergence agitation was observed in the recovery time after general anesthesia. Results During recovery time, heart rate and blood pressure in group A were significantly lower than that in group B (P < 0.05), and the number of patients who were diagnosed as agitation in group A was significantly smaller than that in group B (P < 0.05). Conclusion Use of dexmedetomidine in patients undergoing thoracotomy makes hemodynamics more stable and less agitation during the recovery time after general anesthesia.
[Key words] Anesthesia; Dexmedetomidine; Agitation; Thoracotomy
全麻苏醒期躁动(emergence agitation，EA)为全麻苏醒期一种不恰当的行为，表现为兴奋躁动，定向障碍，无意识动作，挣扎，妄想思维等，常伴有剧烈的血流动力学改变，增加心肌氧耗，可能导致心肌缺血、心律失常，增加脑血管意外的风险，并使手术区出血的风险增加。右美托咪定(dexmedetomidine，DEX)是一种高选择性的α2肾上腺素能受体激动剂，具有镇静、镇痛、抗焦虑等效应，且对患者自主呼吸影响轻。近年来国内外较多研究表明围术期使用右美托咪定能够有减轻手术应激反应，维持术中血流动力学稳定，减轻术后副作用的发生率[1,2] ......
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