摘要
目的：观察持续泵注右美托咪定对双腔管置入开胸患者拔管时血流动力学、苏醒质量、应激反应的影响。方法选择开胸手术患者60例，采用数字表法随机分为0．9％氯化钠注射液组（N 组，n ＝30）、右美托咪定组（D 组，n ＝30），两组诱导前20 min 分别持续泵注0．9％氯化钠注射液、右美托咪定，分别记录术中两组各时间点的平均动脉压（MAP）、心率（HR）、血氧饱和度（SpO2），T0与 T3时间抽取动脉血5 mL，离心冻存检测肾上素水平。记录拔管时间、苏醒期躁动发生率、定向力恢复时间、拔管质量评分。结果D 组 T0、T1、T2、T3、T4时间点 MAP 分别为（97±15）mmHg、（102±12）mmHg、（103±11）mmHg、（98±12）mmHg、（96±13）mmHg，HR 分别为（69±9）次／min、（80±6）次／min、（90±7）次／min、（74±5）次／min、（73±6）次／min， SpO2分别为（95±3）％、（98±2）％、（98±2）％、（95±3）％、（96±2）％；N 组 T0、T1、T2、T3、T4时间点 MAP分别为（96±15）mmHg、（112±16）mmHg、（120±12）mmHg、（117±14）mmHg、（102±15）mmHg，HR 分别为（68±7）次／min、（84±8）次／min、（105±6）次／min、（89±6）次／min、（80±7）次／min，SpO2分别为（96±2）％、（98±2）％、（97±3）％、（93±3）％、（92±4）％；D 组不同时间 MAP、HR、SpO2显著低于 N 组，差异均有统计学意义（MAP：tT1＝2．74、tT2＝5．72、tT3＝25．63、tT4＝1．66，均 P ＜0．05；HR：tT1＝2．20、tT2＝8．91、tT3＝10．52、tT4＝4．16，均 P ＜0．05；SpO2：tT1＝0．00、tT2＝1．52、tT3＝2．58、tT4＝4．9，PT3＜0．05、PT4＜0．05）。D 组定向力恢复时间、躁动评分、拔管质量评分分别为（3．3±2．2）min、（1．3±0．9）分、（2．1±1．2）分，N 组分别为（5．2±2.3）min、（2．4±1．2）分、（3．2±1．4）分，两组差异均有统计学意义（t ＝3．27、2．40、3．27，均 P ＜0．05）。N 组T3时间点肾上腺激素为（120±25．3）pmol／L，高于 D 组的（93．4±23．2）pmol／L，差异有统计学意义（t ＝4．24， P ＝0.00）。N 组镇痛药用量[苏芬太尼（60．5±9．2）μg，瑞芬太尼（3．3±0．8）mg]明显大于 D 组[苏芬太尼（40．4±10．2）μg，瑞芬太尼（2．4±0．9）mg]，差异均有统计学意义（t ＝8．02、4．09，均 P ＜0．01）。结论持续泵注右美托咪定能提高双腔管置入手术患者苏醒质量，减轻心血管反应。
Objective To observe the effect of continuous pumped dexmedetomidine on hemodynamics, awakening quality and stress response in double -lumen tube extubation patients.Methods 60 patients with thoracic surgery were divided into saline group（group N,n =30）and Dex group（group D,n =30）.Both two groups were continuously pumped NS and dexmedetomidine respectively 20min before anesthesia.MAP,HR and SpO2 at different time points during the surgery were recorded.Extracted 5ml arterial blood at the time point of T0 and T3,centrifugated and stored at -80 ℃ for testing renin levels.The extubation time,restlessness incidence,orientation recovery time, extubation quality score were recorded.Results The values of MAP in group D at time points of T0,T1,T2,T3,T4 were （97 ±15）mmHg,（102 ±12）mmHg,（103 ±11）mmHg,（98 ±12）mmHg,（96 ±13）mmHg.The values of HR in group D at different time points were （69 ±9）times/min,（80 ±6）times/min,（90 ±7）times/min,（74 ±5）times/min,（73 ±6）times/min.The values of SpO2 in group D at different time points were （95 ±3）%,（98 ±2）%,（98 ± 2）%,（95 ±3）%,（96 ±2）%.The values of MAP in group N at time points of T0,T1,T2,T3,T4 were （96 ± 15）mmHg,（112 ±16）mmHg,（120 ±12）mmHg,（117 ±14）mmHg,（102 ±15）mmHg.The values of HR in group N at different time points were （68 ±7）times/min,（84 ±8）times/min,（105 ±6）times/min,（89 ±6）times/min, （80 ±7）times/min.The values of SpO2 in group N at different time points were （96 ±2）%,（98 ±2）%,（97 ± 3）%,（93 ±3）%,（92 ±4）%.The values of MAP,HR,SpO2 at different time points in group D were significantly lower than those in group N,the differences were statistically significant （the t values of MAP at different time points were tT1 =2.74,tT2 =5.72,tT3 =25.63,tT4 =1.66,all P 〈0.05;the t values of HR at different time points were tT1 =2.20,tT2 =8.91,tT3 =10.52,tT4 =4.16,all P 〈0.05;the t values of SpO2 at different time points were tT1 =0.00,tT2 =1.52,tT3 =2.58,tT4 =4.9,PT3 〈0.05,PT4 〈0.05）.There was significant difference between the two groups in orientation recovery time[（3.3 ±2.2）min vs （5.2 ±2.3）min,P =0.0018].There was significant difference between the two groups in agitation score[（1.3 ±0.9）vs （2.4 ±1.2）].There was significant difference between the two groups in extubation quality score[（2.1 ±1.2）vs （3.2 ±1.4）,P =0.0018].There was statistical difference between the two groups in T3 adrenal hormones[（N：120 ±25.3）pmol/L,（D：93.4 ±23.2）pmol/L,P =0.00].The dose of sufentanil （60.5 ±9.2）μg in group N was higher than （40.4 ±10.2）μg in group D （P =0.001）.The dose of remifentanil （3.3 ±0.8）mg in group N was higher than （2.4 ±0.9）mg in group D （P =0.001）.Conclusion Continuous pumped dexmedetomidine can effectively improve awakening quality of patients with double -lumen tube.
出处
《中国基层医药》
CAS
2016年第13期2035-2039,共5页
Chinese Journal of Primary Medicine and Pharmacy
关键词
右美托咪定
苏醒期
心血管反应
肾上腺素
Dexmedetomidine
Awakening time
Cardiovascular responses
Adrenaline levels
作者简介
通信作者：张蓬勃，Email：zhpbo@163．com
