汪芳俊,胡建華,李洪瓊,王藝錚,曾悅怡
藥物臨床觀察
右美托咪定對(duì)七氟醚麻醉患者蘇醒呼末七氟醚濃度的影響
汪芳俊,胡建華,李洪瓊,王藝錚,曾悅怡
目的 觀察術(shù)中輸注不同劑量右美托咪定對(duì)七氟醚麻醉患者蘇醒時(shí)呼末七氟醚濃度及躁動(dòng)的影響。方法 擇期行單側(cè)乳腺癌根治術(shù)患者120例,年齡35~56歲,隨機(jī)分為4組,每組30例。D0.5、D0.6、D0.7組分別給予右美托咪定0.5、0.6、0.7 μg/(kg·h),C組給予生理鹽水;觀察并記錄患者術(shù)中、術(shù)后各時(shí)段呼末七氟醚濃度,記錄患者蘇醒時(shí)呼末七氟醚濃度,觀察患者蘇醒情況和停藥至蘇醒拔管時(shí)間,觀察患者麻醉蘇醒拔管情況,并根據(jù)Riker’s鎮(zhèn)靜-躁動(dòng)評(píng)分進(jìn)行評(píng)估。記錄手術(shù)時(shí)間、麻醉時(shí)間、術(shù)中瑞芬太尼用量、術(shù)中聽覺誘發(fā)電位指數(shù)(AAI)、七氟醚吸入濃度及相應(yīng)時(shí)間。結(jié)果 4組患者一般資料、瑞芬太尼用量、手術(shù)時(shí)間和術(shù)中AAI值差異均無統(tǒng)計(jì)學(xué)意義,D0.7組麻醉時(shí)間較其他3組延長(zhǎng)(P<0.05)。與C組比較,D0.5、D0.6和D0.7組術(shù)中不同時(shí)段七氟醚吸入濃度均降低,蘇醒時(shí)間延長(zhǎng),蘇醒時(shí)呼末七氟醚濃度降低,且D0.7組蘇醒時(shí)間較D0.5、D0.6組延長(zhǎng),蘇醒時(shí)呼末七氟醚濃度低于D0.5組,與D0.6組差異無統(tǒng)計(jì)學(xué)意義。與C組比較,D0.5、D0.6和D0.7組Riker’s鎮(zhèn)靜-躁動(dòng)評(píng)分達(dá)到7分的比例降低(P<0.05);D0.6和D0.7組評(píng)分達(dá)到4分的比例較C組和D0.5組高,而達(dá)到6分的比例較C組和D0.5組低(P<0.05);D0.7組患者評(píng)分達(dá)到3分的比例高于其他3組(P<0.05)。術(shù)中D0.6組和D0.7組分別有4例(13%)和8例(27%)發(fā)生心動(dòng)過緩。結(jié)論 七氟醚吸入麻醉中靜脈輸注右美托咪定0.6 μg/(kg·h)可有效減少術(shù)中七氟醚的用量并降低蘇醒時(shí)呼末七氟醚濃度,減少患者吸入全麻蘇醒躁動(dòng)的發(fā)生。
麻醉藥,吸入;右美托咪定;七氟醚;吸入麻醉;濃度;蘇醒
吸入麻醉術(shù)后患者蘇醒時(shí)經(jīng)常出現(xiàn)躁動(dòng),容易導(dǎo)致其從手術(shù)臺(tái)或手術(shù)推車墜落等意外傷害發(fā)生。這可能是由于吸入麻醉后患者蘇醒過快,體內(nèi)尚未被排出的吸入麻醉藥導(dǎo)致中樞恢復(fù)時(shí)間不一,大腦皮質(zhì)尚處于抑制狀態(tài)時(shí)皮質(zhì)下中樞已被解放,出現(xiàn)中樞局灶敏化。在某些有害刺激的作用下,中樞神經(jīng)系統(tǒng)表現(xiàn)為過度興奮而誘發(fā)術(shù)后躁動(dòng)[1]。右美托咪定是高效、高選擇性的腎上腺素α2受體激動(dòng)藥,具有鎮(zhèn)痛和劑量依賴性鎮(zhèn)靜作用[2]。目前關(guān)于吸入麻醉聯(lián)合術(shù)中輸注右美托咪定能否降低患者清醒時(shí)呼末吸入麻醉藥濃度,從而減少吸入全麻患者蘇醒躁動(dòng)的研究尚少。本研究擬觀察術(shù)中輸注不同劑量的右美托咪定對(duì)七氟醚吸入麻醉患者術(shù)后蘇醒時(shí)呼末七氟醚濃度及躁動(dòng)的影響,為臨床減少吸入麻醉后患者蘇醒躁動(dòng)提供參考。
1.1 一般資料 經(jīng)本院醫(yī)學(xué)倫理委員會(huì)批準(zhǔn),患者及家屬簽署知情同意書。選擇2014年1月—10月來我院擇期行單側(cè)乳腺癌根治術(shù)患者120例,年齡35~56歲,體質(zhì)量42~65 kg,ASA分級(jí)Ⅰ~Ⅱ級(jí),肝腎功能未見異常,無高血壓和糖尿病史,無藥物或酒精成癮史,意識(shí)狀態(tài)和認(rèn)知功能無異常。采用隨機(jī)數(shù)字表法將所有患者分為D0.5、D0.6、D0.7組和對(duì)照組(C組),每組30例。
1.2 麻醉方法 所有患者均無術(shù)前用藥,入手術(shù)室后建立靜脈通道。采用邁瑞B(yǎng)ene View T8多參數(shù)監(jiān)護(hù)儀監(jiān)測(cè)患者心率(HR)、心電圖(ECG)、脈搏氧飽和度(SpO2)、收縮壓(SBP)、舒張壓(DBP)、體溫(T)和呼末二氧化碳分壓[p(CO2)],Organon Teknika(Ireland)公司生產(chǎn)的TOF-Watch SX加速度肌松監(jiān)測(cè)儀監(jiān)測(cè)肌松,丹麥Danmeter A/S公司A-Line麻醉深度監(jiān)測(cè)儀監(jiān)測(cè)聽覺誘發(fā)電位指數(shù)(A-line ARX Index,AAI)的變化。4組患者均行氣管內(nèi)插管全麻,麻醉誘導(dǎo)均采用靜脈注射咪達(dá)唑侖0.04 mg/kg、異丙酚1.5 mg/kg、芬太尼3 μg/kg、阿曲庫(kù)銨0.6 mg/kg。術(shù)中靜脈泵注瑞芬太尼0.2 μg/(kg· min),持續(xù)吸入七氟醚維持麻醉,維持AAI為20~30。其中D0.5組、D0.6組、D0.7組分別靜脈給予右美托咪定0.5、0.6、0.7 μg/(kg·h);C組給予等容量生理鹽水;根據(jù)肌松和麻醉深度監(jiān)測(cè)情況追加肌松藥和增減七氟醚吸入濃度,術(shù)中患者心率低于50次/min,予靜脈注射阿托品0.2~0.4 mg。術(shù)畢前手術(shù)醫(yī)師采用0.5%利多卡因溶液沖洗手術(shù)創(chuàng)面3~5 min,然后關(guān)閉皮膚切口。分別于手術(shù)結(jié)束前40 min、30 min和5 min停止肌松藥、右美托咪定、瑞芬太尼和吸入麻醉藥的使用,并對(duì)吸入麻醉藥進(jìn)行洗出。待患者自主呼吸恢復(fù)良好,蘇醒后拔除氣管導(dǎo)管送麻醉恢復(fù)室,觀察至患者完全清醒后送回病房。
1.3 觀察指標(biāo) 采用Detex-ohmeda S/5麻醉監(jiān)護(hù)儀觀察并記錄術(shù)中、術(shù)后各時(shí)段呼末七氟醚濃度。記錄患者蘇醒時(shí)呼末七氟醚濃度、蘇醒時(shí)間(停止麻醉給藥至患者蘇醒拔管時(shí)間)。記錄手術(shù)時(shí)間、麻醉時(shí)間、術(shù)中AAI值、術(shù)中瑞芬太尼用量、七氟醚吸入濃度及相應(yīng)時(shí)段各組患者術(shù)中心動(dòng)過緩的發(fā)生情況;觀察患者麻醉蘇醒拔管情況并根據(jù)Riker’s鎮(zhèn)靜-躁動(dòng)評(píng)分進(jìn)行評(píng)估[3]。7分:患者拖拽氣管導(dǎo)管,試圖拔除導(dǎo)尿管,翻越擔(dān)架護(hù)欄,攻擊醫(yī)護(hù)人員,左右翻滾。6分:言語(yǔ)交流不能平靜,需要身體束縛,咬氣管導(dǎo)管。5分:焦慮或輕微躁動(dòng),試圖坐起來,言語(yǔ)交流能平靜。4分:平靜,合作。3分:鎮(zhèn)靜狀態(tài),容易喚醒,能遵從指令。2分:深度鎮(zhèn)靜,不能通過交流或命令喚醒,需身體刺激才能喚醒。1分:不能通過交流或命令喚醒,對(duì)傷害刺激沒有或只有輕微反應(yīng)。
1.4 統(tǒng)計(jì)學(xué)方法 采用SAS 8.0統(tǒng)計(jì)軟件進(jìn)行分析。計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差(±s)表示,多組間比較采用單因素方差分析和重復(fù)測(cè)量資料的方差分析,組間兩兩比較采用SNK-q檢驗(yàn)。計(jì)數(shù)資料組間比較采用χ2檢驗(yàn),以P<0.05表示差異有統(tǒng)計(jì)學(xué)意義。
2.1 一般資料、手術(shù)時(shí)間和瑞芬太尼用量等指標(biāo) 4組患者一般資料、瑞芬太尼用量、手術(shù)時(shí)間和術(shù)中AAI值等差異均無統(tǒng)計(jì)學(xué)意義(P>0.05),D0.7組麻醉時(shí)間較其他3組延長(zhǎng)(P<0.05),見表1。
Tab.1 Comparison of clinical data,operation time,anesthesia time,remifentanil dasage,and AAI value during operation between four groups表1 4組患者一般資料、手術(shù)時(shí)間、麻醉時(shí)間、瑞芬太尼用量和術(shù)中AAI值變化比較 (n=30s)
Tab.1 Comparison of clinical data,operation time,anesthesia time,remifentanil dasage,and AAI value during operation between four groups表1 4組患者一般資料、手術(shù)時(shí)間、麻醉時(shí)間、瑞芬太尼用量和術(shù)中AAI值變化比較 (n=30s)
*P<0.05;a與C組比較,b與D0.5組比較,c與D0.6組比較,P<0.05
組別C組D0.5組D0.6組D0.7組F年齡(歲)41.8±6.1 42.4±5.3 43.2±4.5 42.6±5.6 0.529體質(zhì)量(kg)53.4±7.2 51.2±8.6 53.2±6.4 52.1±7.5 0.716瑞芬太尼用量(μg)1 021±117 1 011±102 1 038±111 1 050±124 0.937組別C組D0.5組D0.6組D0.7組F術(shù)中AAI值23.8±2.2 22.4±1.9 23.2±2.4 23.6±2.6 0.681手術(shù)時(shí)間(min)102.3±8.6 100.2±9.4 103.1±10.1 106.3±9.8 0.813麻醉時(shí)間(min)128.4±10.2 131.3±9.7 133.1±10.5 141.2±10.3abc9.380*
2.2 不同時(shí)段七氟醚吸入濃度比較 C組患者術(shù)中不同時(shí)段七氟醚吸入濃度均較其他組高(P<0.05),D0.5組、D0.6組和D0.7組患者術(shù)中不同時(shí)段七氟醚維持濃度比較差異無統(tǒng)計(jì)學(xué)意義,見表2。
Tab.2 Comparison of sevoflurane inhalation concentration at different time points between four groups表2 4組患者不同時(shí)段七氟醚吸入濃度比較(n=30,VOL%,±s)
Tab.2 Comparison of sevoflurane inhalation concentration at different time points between four groups表2 4組患者不同時(shí)段七氟醚吸入濃度比較(n=30,VOL%,±s)
*P<0.05;a與C組比較,P<0.05;F組間=3.413,P=0.086;F時(shí)間= 43.564,P<0.001;F交互=1.641,P=0.241
組別C組D0.5組D0.6組D0.7組F 0~30 min 3.8±0.7 3.1±0.3a3.0±0.4a2.9±0.3a10.295*30~60 min 3.5±0.7 2.8±0.3a2.6±0.4a2.4±0.3a13.617*60~90 min 3.3±0.7 2.7±0.3a2.5±0.4a2.2±0.3a14.378*
2.3 蘇醒時(shí)間和蘇醒時(shí)呼末七氟醚濃度比較 C組患者蘇醒時(shí)間明顯較其他3組患者縮短,蘇醒時(shí)呼末七氟醚濃度顯著高于其他3組(P<0.05)。D0.7組患者蘇醒時(shí)間較 D0.5和 D0.6組顯著延長(zhǎng)(P<0.05),蘇醒時(shí)呼末七氟醚濃度顯著低于D0.5組(P<0.05),與D0.6組比較差異無統(tǒng)計(jì)學(xué)意義,見表3。
Tab.3 Comparison of the palinesthesia time and endtidal concentration of sevoflurane during palinesthesia between four groups表3 4組患者蘇醒時(shí)間和蘇醒時(shí)呼末七氟醚濃度比較(n=30,±s)
Tab.3 Comparison of the palinesthesia time and endtidal concentration of sevoflurane during palinesthesia between four groups表3 4組患者蘇醒時(shí)間和蘇醒時(shí)呼末七氟醚濃度比較(n=30,±s)
*P<0.05;a與C組比較,b與D0.5組比較,c與D0.6組比較,P<0.05
組別C組D0.5組D0.6組D0.7組F蘇醒時(shí)間(min)17.84±0.72 20.21±0.33a21.13±0.42a26.92±0.31abc13.413*呼末七氟醚濃度(VOL%)0.21±0.07 0.15±0.03a0.10±0.04ab0.08±0.03ab15.566*
2.4 Riker’s鎮(zhèn)靜-躁動(dòng)評(píng)分 與C組比較,D0.5、D0.6和D0.7組評(píng)分達(dá)到7分的比例降低(P<0.05)。D0.6和D0.7組評(píng)分達(dá)到 4分的比例較D0.5和 C組高(P<0.05),而達(dá)到 6分的比例較 D0.5和 C組低(P<0.05)。D0.7組患者評(píng)分達(dá)到3分的比例高于其他3組(P<0.05),見表4。
2.5 各組心率變化情況 4組患者中D0.6組和D0.7組分別有4例(13%)和8例(27%)術(shù)中發(fā)生心動(dòng)過緩,靜脈給予阿托品后心率均恢復(fù)正常。
Tab.4 Comparison of Riker’s sedation-agitation scale between four groups表4 4組患者Riker’s鎮(zhèn)靜-躁動(dòng)評(píng)分比較[n=30,例(%)]
3.1 右美托咪定對(duì)吸入全麻藥物的影響 預(yù)試驗(yàn)發(fā)現(xiàn)術(shù)中予右美托咪定0.5~0.7 μg/(kg·h)患者術(shù)中麻醉平穩(wěn),低血壓和心動(dòng)過緩的情況亦較少出現(xiàn),而其劑量達(dá)到0.8 μg/(kg·h)后患者術(shù)中低血壓和心動(dòng)過緩發(fā)生明顯增加。因此,本研究選擇右美托咪定0.5、0.6、0.7 μg/(kg·h)術(shù)中靜脈輸注來研究右美托咪定對(duì)七氟醚麻醉患者蘇醒呼末七氟醚濃度的影響。國(guó)外學(xué)者研究發(fā)現(xiàn)術(shù)中給予右美托咪定0.4~0.6 μg/(kg·h),術(shù)中七氟醚的使用量可減少27.3%~33%[4]。本研究中靜脈泵注右美托咪定各組患者七氟醚的用量均明顯減少,七氟醚的使用量降低了18%~33%,與上述結(jié)果基本一致。表明術(shù)中輸注右美托咪定可以有效減少吸入麻醉藥的用量,這可能與右美托咪定是高效的α2腎上腺素受體激動(dòng)藥,激活藍(lán)斑核突觸前α2腎上腺素受體,產(chǎn)生鎮(zhèn)靜和鎮(zhèn)痛作用有關(guān)[2]。因此,吸入全麻中右美托咪定可以作為有效的麻醉輔助藥減少吸入麻醉藥的用量。
本研究發(fā)現(xiàn)使用右美托咪定患者術(shù)后蘇醒時(shí)呼末七氟醚濃度明顯降低,而且隨著右美托咪定劑量的增大其呼末濃度降低越顯著,這主要由于右美托咪定的鎮(zhèn)靜鎮(zhèn)痛作用使患者術(shù)中對(duì)七氟醚的需求量下降[4],導(dǎo)致七氟醚用量減少。同時(shí)相對(duì)延長(zhǎng)了七氟醚洗出時(shí)間,從而導(dǎo)致患者蘇醒時(shí)呼末七氟醚濃度降低。本研究未對(duì)七氟醚體內(nèi)代謝情況進(jìn)行研究,目前還不清楚右美托咪定的應(yīng)用是否對(duì)七氟醚體內(nèi)代謝有影響,這有待進(jìn)一步研究。術(shù)中輸注右美托咪定組患者術(shù)后蘇醒時(shí)間均有所延長(zhǎng),D0.5和D0.6組相對(duì)D0.7組患者蘇醒時(shí)間明顯縮短,顯示右美托咪定的應(yīng)用可導(dǎo)致患者全麻術(shù)后蘇醒延遲,且右美托咪定劑量越大患者蘇醒的時(shí)間越長(zhǎng)。Kim等[5]研究發(fā)現(xiàn)術(shù)中輸注右美托咪定并不影響患者的蘇醒。這可能是因?yàn)樗麄冊(cè)谛g(shù)中給患者輸注的右美托咪定劑量[0.1 μg/(kg·h)],與本研究術(shù)中輸注的劑量[0.5~0.7 μg/(kg·h)]不同造成的。
3.2 右美托咪定對(duì)全麻術(shù)后患者蘇醒期躁動(dòng)的影響 Riker’s鎮(zhèn)靜-躁動(dòng)評(píng)分顯示,評(píng)分4分為最優(yōu)狀態(tài),低于4分則患者處于鎮(zhèn)靜狀態(tài),且評(píng)分越低鎮(zhèn)靜程度越深,而高于4分則患者處于躁動(dòng)狀態(tài),且隨躁動(dòng)強(qiáng)度加大而評(píng)分逐漸增加[3]。本研究中D0.6、D0.7組與C組、D0.5組患者相比評(píng)分達(dá)到4分的比例顯著增高,而D0.7組評(píng)分大于5分的比例明顯降低,但D0.7組患者評(píng)分達(dá)到3分的比例明顯較其他3組高,表明術(shù)中輸注0.6~0.7 μg/(kg·h)的右美托咪定可有效降低患者全麻蘇醒期發(fā)生躁動(dòng)的比例,但右美托咪定按0.7 μg/(kg·h)輸注后將會(huì)導(dǎo)致6.7%患者術(shù)后處于過度鎮(zhèn)靜狀態(tài),從而延長(zhǎng)患者在麻醉恢復(fù)室時(shí)間。因此,術(shù)中0.6 μg/(kg·h)輸注右美托咪定相對(duì)來說是一個(gè)比較理想的選擇。
全麻術(shù)后患者蘇醒期躁動(dòng)的影響因素很多,不僅與手術(shù)部位[6]、麻醉方式[1]、性別[7]和年齡[8]有關(guān),還與術(shù)后疼痛、尿管刺激、氣管導(dǎo)管刺激等有關(guān)[9]。本研究中只選擇了中年女性單側(cè)乳腺癌患者,術(shù)中均采用七氟醚吸入麻醉,手術(shù)醫(yī)師術(shù)畢前采用0.5%利多卡因生理鹽水混合液沖洗手術(shù)創(chuàng)面,因此排除了手術(shù)部位、麻醉方式、年齡和性別的差異,同時(shí)消除了患者術(shù)后蘇醒期手術(shù)部位疼痛的影響,因此患者術(shù)后的應(yīng)激反應(yīng)主要由氣管導(dǎo)管和尿管刺激引起。D0.6和D0.7組患者全麻蘇醒后對(duì)上述刺激的耐受度明顯較其他兩組好,這與右美托咪定的鎮(zhèn)靜陣痛作用有關(guān)[10]。本試驗(yàn)中D0.6和D0.7組患者蘇醒時(shí)呼末七氟醚濃度明顯較C組和D0.5組患者低,術(shù)后躁動(dòng)比例也顯著降低,表明術(shù)后吸入全麻藥的充分洗出可以減少患者術(shù)后蘇醒躁動(dòng)的發(fā)生。研究表明咪達(dá)唑侖通過作用于其GABAA(γ-aminobutyricacid)靶位點(diǎn)減少七氟醚全麻蘇醒期躁動(dòng),該作用與兩藥濃度以及γ2亞基選擇性結(jié)合有關(guān)[11]。目前七氟醚全麻患者蘇醒期易發(fā)生躁動(dòng)的具體機(jī)制還不清楚,有待下一步研究。
3.3 右美托咪定對(duì)循環(huán)系統(tǒng)的影響 右美托咪定因作用于中樞腎上腺素α2受體可以導(dǎo)致心動(dòng)過緩和低血壓[12]。本研究中只有D0.6組和D0.7組分別有4例(13%)和8例(27%)患者術(shù)中發(fā)生心動(dòng)過緩,經(jīng)過靜脈給予阿托品后心率均恢復(fù)正常,術(shù)中沒有患者發(fā)生低血壓。
綜上所述,七氟醚吸入麻醉中靜脈輸注右美托咪定0.6 μg/(kg·h)可有效減少術(shù)中七氟醚的用量和和降低蘇醒時(shí)呼末七氟醚濃度,并減少患者吸入全麻蘇醒躁動(dòng)的發(fā)生。
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(2015-11-18收稿 2016-02-25修回)
(本文編輯 李鵬)
The effect of dexmedetomidine on the end-tidal concentration of sevoflurane during recovery from breast cancer surgery under general anaesthesia
WANG Fangjun,HU Jianhua,LI Hongqiong,WANG Yizheng,ZENG Yueyi
Department of Anesthesiology,the Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China
Objective To investigate the effects of dexmedetomidine on the end-tidal concentration of sevoflurane during recovery from breast cancer surgery under general anaesthesia.Methods A total of 120 patients undergoing unilateral breast cancer radical operation were randomly divided into four groups:group C(infusion of saline,n=30),group D0.5[infusion of dexmedetomidine 0.5 μg/(kg·h)during operation,n=30],group D0.6[dexmedetomidine 0.6 μg/(kg·h),n=30]and group D0.7[dexmedetomidine 0.7 μg/(kg·h),n=30].The end-tidal concentrations of sevoflurane during surgery and postoperation were observed.The end-tidal concentration of sevoflurane on palinesthesia was recorded.The time from stopping administration of anesthetic drug to palinesthesia and the operation time were recorded.The palinesthesia of patients from general anaesthesia and the degree of emergence agitation of the patient were measured using Riker’s sedation-agitation scale.The operation time,anesthesia time,intraoperative remifentanil dosage,intraoperative auditory evoked potential index(AAI),sevoflurane inhalation concentration and the corresponding time were recorded.Results There were no significant differences in clinical data,remifentanil dosage,operation time and AAI between four groups.The anesthesia time was longer in group D0.7than that in the other three groups(P<0.05).Compared to group C,the end-tidal concentration of sevoflurane during surgery,postoperation and palinesthesia were lower and the time of palinesthesia was delayed in groups D0.5,D0.6and D0.7(P<0.05).And the time of palinesthesia was delayed in group D0.7than that of group D0.5and group D0.6.Compared with group C,the ratio of Riker’s sedation-agitation scale>7 was lower in groups D0.5,D0.6and D0.7(P<0.05).The ratio of Riker’s sedation-agitation scale>4 was significantly higher in group D0.6and group D0.7than that in group C and group D0.5,but the ratio of score>6 was lower(P<0.05).The ratio of score>3 was higher in group D0.7than that of other three groups(P<0.05).Intraoperative cardiac tachycardia was found in group D0.6and group D0.7(4 cases,13%and 8cases,7%).Conclusion Sevoflurane inhalation anesthesia and intravenous infusion of dexmedetomidine 0.6 μg/(kg·h)can effectively reduce intraoperative sevoflurane dosage,the end-tidal concentration of sevoflurane during recovery,and the occurrence of agitation in patients undergoing general anesthesia.
anesthetics,inhalation;Dexmedetomidine;sevoflurane;inhalation anesthesia;concentration;palinesthesia
R614.2
A
10.11958/20150313
四川省醫(yī)學(xué)會(huì)課題(EH-MN14-06)
川北醫(yī)學(xué)院附屬醫(yī)院麻醉科(郵編637000)
汪芳?。?972),男,副主任醫(yī)師,碩士,主要從事臨床麻醉藥理學(xué)研究