胃肠手术中右旋美托咪定对全麻复苏期的影响

目的 探讨全身麻醉中全程复合应用右旋美托咪定对患者复苏期拔管时间、睁眼时间和血流动力学等指标的影响.方法 90例入选患者被随机分成试验Ⅰ组（T1）、试验Ⅱ组（T2）和对照组（C）3组.试验Ⅰ组患者15 min内输注0.5 μg/kg右旋美托咪定,以0.25 μg· kg-1· h-1右旋美托咪定维持至拔管;试验Ⅱ组15 min内输注0.5 μg/kg右旋美托咪定,以0.5 μg· kg-1· h-1右旋美托咪定维持至拔管;对照组（C） 输注生理盐水.记录复苏期拔管时间、睁眼时间和血流动力学变化.结果 麻醉复苏期停止输注丙泊酚至拔出气管导管时间分别为C 组（26.6 ± 8.8）min、T1组（36.0 ± 12.9）min和T2 组（33.0 ± 7.7）min,3组间比较差异无统计学意义.停止瑞芬太尼输注到拔出气管导管时间分别为 C 组（12.4 ± 7.4） min,T1 组（17.2 ± 9.9） min和T2 组（16.1 ± 7.9） min,3组间比较无统计学差异（P 〉 0.05）.睁眼时间T1为（22.1 ± 9.5）min、T2为（37.3 ± 7.4） min,均较对照组C（13.2 ± 4.8）min明显延长（P 〈 0.05）.麻醉复苏期血压、心率变化试验组较对照组稳定,T2组尤为明显.结论 成人胃肠手术全凭静脉麻醉全程复合较大剂量（0.5 μg· kg-1· h-1）右旋美托咪定对麻醉复苏期气管拔管时间无明显影响,但可延长睁眼时间并与剂量相关;复苏期血流动力学指标更平稳.

Effect of dexmedetomidine on the recovery period of general anesthesia in patients undergoing gastrointestinal surgery

Objective To assess whether intraoperative infusion of dexmedetomidine can reduce the time of extubation and opening eyes and make hemodynamic more smooth in extubation. Methods Nighty patients were randomly assigned to three groups. Group T1(n = 30) received a loading dose of dexmedetomidine 0.5 mg/kg iv during 15 min, followed by a continuous infusion at a rate of 0.5 μg·kg-1 ·h-1 throughout the operation. Group T2 (n = 30) received a loading dose of dexmedetomidine 0.5 mg/kg iv during 15 min, followed by a continuous infusion at a rate of 0.25 μg·kg-1·h-1 throughout the operation. Group C (n = 30) received a volume-matched bolus and infusion of placebo (0.9% saline). The recovery time from stopping propofol or remifentanil to extubation, the time from stopping remifentanil to open eyes, and the hemodynamic in extubation were recorded. Results The time from stopping infused propofol (TSP) group C: (26.5 ± 8.8) min; group T1: (36.0 ± 12.8) min; group T2: (33.0 ± 7.6) min or remifentanil (TSR) group C: (12.4 ± 7.4) min; group T1: (17.1 ± 9.9)min; group T2: (16.0 ± 7.9) min] to extubation were not significantly different. The time to opening eye in group T1 (22.1 ± 9.5 min) and T2 (37.2 ± 7.3 min) were significantly longer than that in control group (13.1 ± 4.8 min)(P < 0.05). The blood pressure and heart rate were more stable in group T1 and T2 than in control group during anesthesia recovery period. Conclusion Continuous iv dexmedetomidine during abdominal surgery don’t affect the time of tracheal extubation but prolong the time of opening eyes. The hemodynamic parameters are more stable during anesthesia recovery period when dexmedetomidine is co-administrated.