不同剂量右美托咪定对胸科手术全麻患者苏醒质量的影响

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• 英文论文题名：Impacts of Dexmedetomidine in Different Doses upon Quality of Recovery from General Anaesthesia in Patients Undergoing Thoracic Surgeries
• 论文作者：丁亚军 ; 宋容燕 ; 曹汉忠 ; 钱燕宁 ; 陈海涛
• 英文论文作者：Ding Yajun ; Song Rongyan ; Cao Hanzhong ; Chen Haitao ; Qian Yanning ; Department of Anesthesia ; Affiliated Tumor Hospital Nantong University
• 年：2016
• 作者机构：南通大学附属肿瘤医院麻醉科;江苏省人民医院;
• 论文关键词：胸科手术 ; 右美托咪定 ; 苏醒质量
• 英文论文关键词：Thoracic Surgeries ; Dexmedetomidine ; Quality of Recovery
• 会议召开时间：2016-12-01
• 会议录名称：中国医师进修论文选编
• 语种：中文
• 分类号：R614
• 学会代码：BCLK
• 会议名称：2016年12月中国医师进修学术交流会
• 会议地点：中国北京
• 主办单位：中国医师进修编委会
• 学会名称：百川利康（北京）国际医学研究院
• 页数：4
• 文件大小：518k
• 原文格式：D
• 会议级别：全国

摘要

目的观察不同剂量右美托咪定对胸科手术全身麻醉患者苏醒质量的影响。方法择期行胸科手术患者60例,ASAⅠ~Ⅲ级,年龄40~65岁,随机数字表法分为三组,低剂量右美托咪定组(B_1组,n=20)、高剂量右美托咪定组(B_2组,n=20)、对照组(A组,n=20)。B_1组及B_2组术中分别予以右美托咪定0.2ug·kg~(-1)·h~(-1)和0.4ug·kg~(-1)·h~(-1)泵至手术结束,A组泵注等容量生理盐水。三组患者术中均为单肺通气(OLV)。观察三组患者术毕自主呼吸恢复时间(T_1)、苏醒时间(T_2)、拔管时间(T_3)、Steward苏醒评分达到6分时间(T4);记录拔管后2h(T_5)、8h(T_6)、24h(T_7)苏醒期Ramsay镇静评分;术后3d内谵妄的发生情况(采用谵妄评估量表);术后7d认知功能障碍评价(采用MMSE评分)。结果与A组比较,B_1组、B_2组术后躁动程度明显降低(p<0.05);B_1组患者恢复到T_4时点明显短于A组及B_2组(p<0.05),B_2组患者恢复到T_1、T_2、T_3时点分别明显长于A组及B_1组(p<0.05);T_5即刻B_1组Ramsay评分明显低于A组及B_2组(p<0.05);与A组比较,B_1及B_2组术后3d内谵妄发生率低(p<0.05),术后7d认知功能障碍发生率差异无统计学意义。结论胸科手术全身麻醉予以低剂量右美托咪定可以提高患者苏醒质量,值得临床推广。
Objective To observe the impacts of dexmedetomidine in different doses upon quality of recovery from general anaesthesia in patients undertaking thoracic surgeries. Method 60 ASAⅠ~Ⅲgrade and 40-to-60-year-old patients receiving thoracic surgeries were enrolled and divided into three groups by random number table, including Low-dose Dexmedetomidine Group(Group B_1, n=20), High-dose Dexmedetomidine Group(Group B_2, n=20) and Control Group(Group A, n=20). During their operations, patients of groups B_1 and B_2 were medicated with dexmedetomidine at 0.2ug·kg-1·h-1 and 0.4ug·kg-1·h-1 respectively by infusion pump until the operation ended, while patients of Group A were infused the same volume of normal saline. In all three groups of patients, one-lung ventilation(OLV) was performed. Time of post-operative spontaneous breathing recovery(T_1), recovery time(T_3), extubation time(T_3) and time for Steward recovery?scores to reach 6(T_4) were observed in three groups of patients. The sedation Ramsay scores after extubation of 2h(T_5), 8h(T_6) and 24h(T_7), the incidence of delirium within 3 days after operations(delirium rating scale was used) and evaluation of postoperative cognitive dysfunction within 7 days(by MMSE) were recorded during the recovery. Results Compared with Group A, the postoperative agitation significantly declined in groups B_1 and B_2(p<0.05). The time of recovery to T_4 was much shorter in Group B_1 than Group A and Group B_2(p<0.05). The time of recovery to T_1, T_2 and T_3 was significantly longer for Group B_2 than groups A and B_1(p<0.05). At T_5, Ramsay scores were significantly lower in Group B_1 than groups A and B_2(p<0.05). Compared with Group A, the post-operative incidence of delirium within 3 days was lower in groups B_1 and B_2(p<0.05). The differences in post-operative cognitive dysfunctions were not statistically significant. Conclusion: Patients' quality of recovery could be improved when they were administered low-dose dexmedetomidine in the general anaesthesia of thoracic surgeries.

引文

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