摘要
目的探讨麻醉诱导前给予右美托咪定对脊柱侧弯矫形术患者唤醒时间、镇痛效应及血流动力学的影响。方法选取2021年1月~2021年12月间于我院行脊柱侧弯矫形术的患者113例为研究对象,按照简单随机法分为观察组(n=57)和对照组(n=56),观察组在麻醉诱导前给予0.8μg/kg的右美托咪定10 min内静脉泵注体内,对照组在相同时间内泵入等量的生理盐水,而后两组患者均行全身麻醉,比较两组麻醉插管前(T0)、插管后10 min(T1)、唤醒前10 min(T2)、唤醒期间(T3)、唤醒后5 min(T4)、加深麻醉后10 min血流动力学指标[心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_(2))]变化,术后唤醒时间、唤醒质量、唤醒时躁动发生率,拔管即刻、术后2、6、24 h镇痛效果[视觉模拟评分法(VAS)],麻醉前、术后2 h及6 h应激反应[血清皮质醇(Cor)、醛固酮(ALD)、血糖(Glu)]水平及药物安全性。结果HR、MAP组间、时间点、组间×时间点比较,差异均有统计学意义(P<0.05),观察组T3、T4时间段HR、MAP比较差异有统计学意义(P<0.05),SpO_(2)组间、时间点、组间×时间点比较差异均无统计学意义(P>0.05)。观察组唤醒质量显著高于对照组(P<0.05),唤醒时躁动发生率显著低于对照组(P<0.05),两组唤醒时间比较差异无统计学意义(P>0.05)。VAS评分组间、时间点、组间×时间点比较,差异均有统计学意义(P<0.05),组内各时间段比较差异均有统计学意义(P<0.05),观察组术后2、6 h VAS评分显著低于对照组(P<0.05)。Cor、ALD、Glu组间、时间点、组间×时间点比较,差异均有统计学意义(P<0.05),组内各时间段内外周血Cor、ALD、Glu水平均依次递增(P<0.05),且观察组术后2、6 h外周血Cor、ALD、Glu水平均显著高于对照组(P<0.05)。观察组与对照组不良反应率比较,差异无统计学意义(χ^(2)=0.154,P=0.694)。结论脊柱侧弯矫形术麻醉诱导前给予右美托咪定有利于提高术中唤醒质量,降低术中血流动力学波动,改善术后疼痛及应激反应,具有良好的应用价值。
Objective To explore the effects of dexmedetomidine before induction of anesthesia on awakening time,analgesic effect and hemodynamics in patients undergoing scoliosis correction surgery.Methods 113 patients who underwent scoliosis correction surgery in the hospital from January 2021 to December 2021 were selected as the research subjects,and they were divided into the observation group and the control group according to the simple randomization method.The observation group(n=57)was injected intravenously with 0.8μg/kg dexmedetomidine within 10 min before anesthesia induction,and the control group(n=56)was injected with the same amount of normal saline during the same time period,and the patients in the two groups were subjected to general anesthesia.The hemodynamic indicators of heart rate(HR),mean arterial pressure(MAP),blood oxygen saturation(SpO_(2))]before anesthesia intubation(T0),at 10 min after intubation(T1),at 10 min before awakening(T2),during awakening(T3),at 5 min after awakening(T4)and at 10 min after deepening anesthesia,postoperative awakening time,awakening quality,incidence rate of agitation during awakening,analgesic effect[Visual Analogue Scale(VAS)]immediately after extubation and at 2 h,6 h and 24 h after surgery,stress response[serum cortisol(Cor),aldosterone(ALD),blood glucose(Glu)]before anesthesia and at 2 h and 6 h after surgery and drug safety were compared between the two groups.Results There were statistical differences in group effect,time-point effect and interaction effect of between-group×time-point of HR and MAP(P<0.05),and the differences in HR and MAP at T3 and T4 in observation group were statistically significant(P<0.05).There were no statistical differences in the between-group effect,time-point effect and interaction effect of between-group×time-point of SpO_(2)(P>0.05).The quality of awakening in observation group was significantly higher than that in control group(P<0.05),and the incidence rate of agitation during awakening was significantly lower than that in control group(P<0.05),and there was no statistical difference in the awakening time between the two groups(P>0.05).The differences in between-group effect,time-point effect and interaction effect of between-group×time-point of VAS score were statistically significant(P<0.05),and the difference at each time period within the groups was statistically significant(P<0.05),and the VAS score in observation group was significantly lower than that in control group at 2 h and 6 h after surgery(P<0.05).The between-group effect,time-point effect and interaction effect of levels of peripheral blood Cor,ALD and Glu were statistically different(P<0.05),and the levels at each time period within the groups were increased in turn(P<0.05),and the levels of Cor,ALD and Glu in peripheral blood in observation group at 2 h and 6 h after surgery were significantly higher than those in control group(P<0.05).The rate of adverse reaction was 5.26%in observation group and 8.93%in control group(χ^(2)=0.154,P=0.694).Conclusion Dexmedetomidine before anesthesia induction in scoliosis correction surgery is beneficial to improving the intraoperative awakening quality,reducing the intraoperative hemodynamic fluctuations and improving the postoperative pain and stress response,with good application value.
作者
周雪丹
张科
吴卫
于明帅
吴晓红
ZHOU Xuedan;ZHANG Ke;WU Wei;YU Mingshuai;WU Xiaohong(Department of Anesthesiology,The Second Affiliated Hospital of Chengdu Medical College,No.416 Hospital of Nuclear Industry,Chengdu 610000,China)
出处
《西部医学》
2023年第2期282-286,292,共6页
Medical Journal of West China
基金
四川省卫生健康科研课题普及项目(19PJ210)。
