静脉注射右美托咪定对甲状腺手术患者全麻苏醒的影响研究(1)
【摘要】 目的：研究不同剂量右美托咪定(DEX)静脉注射对甲状腺手术患者全麻苏醒质量的影响。方法：选择2014年3月-2016年12月本院普外科择期全麻下行甲状腺手术患者140例，ASAⅠ或Ⅱ级，采用随机数字表法将患者均分对照组(C组)、DEX1组(D1组)、DEX2组(D2组)和DEX3组(D3组)，每组35例。在手术结束前30 min C组静脉注射20 mL 0.9%氯化钠溶液，D1、D2和D3組分别静脉注射DEX 0.3、0.5、0.7 μg/kg，10 min输注完毕。观察并记录各组患者全麻诱导前(T1)、DEX给药前(T2)、DEX给药后15 min(T3)、拔管即刻(T4)、拔管后10 min(T5)的平均动脉压(MAP)和心率(HR)；记录各组患者睁眼时间、拔管时间、拔管后10 min Ramsay镇静评分、自主呼吸恢复时间及围拔管期不良反应发生率。结果：四组患者T1、T2时的MAP和HR比较，差异均无统计学意义(P>0.05)；D3组T3时的MAP、HR均低于其他三组(P<0.05)；D2组、D3组T4、T5时的MAP和HR均低于C组、D1组(P<0.05)；D1组T4、T5时的MAP、HR与C组比较，差异均无统计学意义(P>0.05)；C组、D1组T4时MAP及HR均高于T1时(P<0.05)。D3组的睁眼时间、自主呼吸恢复及拔管时间均长于其他三组(P<0.05)，D2组、D3组Ramsay评分为5～6分的患者均多于C组、D1组(P<0.05)，C组Ramsay评分为1分的患者多于D2组、D3组(P<0.05)。D2组、D3组围拔管期呛咳发生率均低于C组和D1组(P<0.05)，D2组与D3组比较，差异无统计学意义(P>0.05)，C组和D1组比较，差异无统计学意义(P>0.05)；D3组围拔管期低血压发生率高于C组、D1组、D2组(P<0.05)，C组围拔管期高血压发生率高于D2组、D3组(P<0.05)。结论：甲状腺全麻手术患者手术结束前30 min静脉注射DEX 0.5 μg/kg、0.7 μg/kg能减少恶心呕吐、呛咳等不良反应的发生，维持围拔管期血流动力学的平稳，且不影响患者苏醒及拔管时间，苏醒质量更高，0.7 μg/kg给药效果比0.5 μg/kg更好，值得临床推广使用。
, 百拇医药
【关键词】 右美托咪定； 甲状腺手术； 围拔管期； 不良反应
Effects of Dexmedetomidine Intravenous Infusion on General Anesthesia Recovery in Patients Undergoing Thyroid Surgery/ZHANG Xiaohua，LI Xirong.//Medical Innovation of China，2018，15(01)：022-026
【Abstract】 Objective：To investigate the influence of different doses of Dexmedetomidine (DEX) intravenous infusion on general anesthesia recovery in patients undergoing thyroid surgery.Method：140 patients，ASAⅠ or Ⅱ，scheduled for selective thyroid surgery under general anesthesia，from the department of general surgery in our hospital from March 2014 to December 2016，they were divided into 4 groups by random number table，control group (group C)，DEX 1 group(group D1)，DEX 2 group (group D2)，DEX 3 group (group D3)，35 cases in each group.Group C was treated intravenously with normal saline 20 mL，while groups D1，D2 and D3 were received DEX at the dose of 0.3，0.5，0.7 μg/kg respectively over 10 min，in 30 min before the end of operation.Mean arterial pressure(MAP) and heart rate(HR) were recorded at following five time points：before anesthesia(T1)，before DEX administration(T2)，15 min after DEX administration(T3)，extubation(T4)，10 min after extubation(T5).The time of eye opening and extubation，Ramsay score in 10 min after extubation，the recovery time of spontaneous breathing and the incidence of adverse effects during peri-extubation were recorded.Result：The differences of MAP and HR between the four groups at T1 and T2 were not statistically significant(P>0.05)；at T3，the MAP and HR of D3 group were lower than those of the other three groups (P<0.05)；at T4 and T5，the MAP and HR of group D2 and group D3 were lower than those of group C and group D1(P<0.05)；at T4 and T5，the MAP and HR of group D1 compared with group C，the differences were not statistically significant(P>0.05)；at T4，the MAP and HR of group C and group D1 were higher than those of T1(P<0.05).The eye opening time，spontaneous breathing recovery and extubation time in group D3 were longer than those in the other three groups(P<0.05)，the number of patients with Ramsay score of 5-6 increased in group D2 and group D3 compared with group C and group D1(P<0.05)， and the number of patients with Ramsay score of 1 in group C was more than that of group D2 and group D3(P<0.05).the incidence of cough in group D2 and group D3 was lower than those in group C and group D1(P<0.05)，there was no significant difference between the group D2 and group D3 (P>0.05)，and there was no significant difference between the group C and group D1(P>0.05)；The incidence of hypotension during peri-extubation in group D3 was higher than that in group C and D1，D2 (P<0.05)，and the incidence of hypertension in group C was higher than that in group D2 and group D3(P<0.05).Conclusion：DEX intravenous infusion with 0.5，0.7 μg/kg in patients undergoing thyroid surgery under general anesthesia in 30 min before the end of surgery can reduce the incidence of nausea and vomiting，cough and other adverse reactions，maintain stable hemodynamics during peri-extubation，does not affect the time of spontaneous breathing recovery and extubation of patients，has higher recovery quality and the administration effect of 0.7 μg/kg is better than 0.5 μg/kg，which is worthy of clinical use., 百拇医药(张孝华 李喜荣)
, 百拇医药
【关键词】 右美托咪定； 甲状腺手术； 围拔管期； 不良反应
Effects of Dexmedetomidine Intravenous Infusion on General Anesthesia Recovery in Patients Undergoing Thyroid Surgery/ZHANG Xiaohua，LI Xirong.//Medical Innovation of China，2018，15(01)：022-026
【Abstract】 Objective：To investigate the influence of different doses of Dexmedetomidine (DEX) intravenous infusion on general anesthesia recovery in patients undergoing thyroid surgery.Method：140 patients，ASAⅠ or Ⅱ，scheduled for selective thyroid surgery under general anesthesia，from the department of general surgery in our hospital from March 2014 to December 2016，they were divided into 4 groups by random number table，control group (group C)，DEX 1 group(group D1)，DEX 2 group (group D2)，DEX 3 group (group D3)，35 cases in each group.Group C was treated intravenously with normal saline 20 mL，while groups D1，D2 and D3 were received DEX at the dose of 0.3，0.5，0.7 μg/kg respectively over 10 min，in 30 min before the end of operation.Mean arterial pressure(MAP) and heart rate(HR) were recorded at following five time points：before anesthesia(T1)，before DEX administration(T2)，15 min after DEX administration(T3)，extubation(T4)，10 min after extubation(T5).The time of eye opening and extubation，Ramsay score in 10 min after extubation，the recovery time of spontaneous breathing and the incidence of adverse effects during peri-extubation were recorded.Result：The differences of MAP and HR between the four groups at T1 and T2 were not statistically significant(P>0.05)；at T3，the MAP and HR of D3 group were lower than those of the other three groups (P<0.05)；at T4 and T5，the MAP and HR of group D2 and group D3 were lower than those of group C and group D1(P<0.05)；at T4 and T5，the MAP and HR of group D1 compared with group C，the differences were not statistically significant(P>0.05)；at T4，the MAP and HR of group C and group D1 were higher than those of T1(P<0.05).The eye opening time，spontaneous breathing recovery and extubation time in group D3 were longer than those in the other three groups(P<0.05)，the number of patients with Ramsay score of 5-6 increased in group D2 and group D3 compared with group C and group D1(P<0.05)， and the number of patients with Ramsay score of 1 in group C was more than that of group D2 and group D3(P<0.05).the incidence of cough in group D2 and group D3 was lower than those in group C and group D1(P<0.05)，there was no significant difference between the group D2 and group D3 (P>0.05)，and there was no significant difference between the group C and group D1(P>0.05)；The incidence of hypotension during peri-extubation in group D3 was higher than that in group C and D1，D2 (P<0.05)，and the incidence of hypertension in group C was higher than that in group D2 and group D3(P<0.05).Conclusion：DEX intravenous infusion with 0.5，0.7 μg/kg in patients undergoing thyroid surgery under general anesthesia in 30 min before the end of surgery can reduce the incidence of nausea and vomiting，cough and other adverse reactions，maintain stable hemodynamics during peri-extubation，does not affect the time of spontaneous breathing recovery and extubation of patients，has higher recovery quality and the administration effect of 0.7 μg/kg is better than 0.5 μg/kg，which is worthy of clinical use., 百拇医药(张孝华 李喜荣)