右美托咪定对在局部浸润麻醉下甲状腺手术患者血流动力学和呼吸的影响

摘要

【目的】观察右美托咪定对在局部浸润麻醉下甲状腺手术患者血流动力学和呼吸的影响，并探讨其剂量选择。【方法】选择207例择期行局部浸润麻醉甲状腺手术患者，按照随机数字表分为高剂量组、低剂量组及对照组。局麻前均给予芬太尼10．μg／kg静脉注射。高剂量组、低剂量组患者加用相应剂量右美托咪定，比较各组患者手术期间血流动力学及呼吸变化。【结果】对照组手术期间平均动脉压（MAP）、心率（HR）显著上升，高剂量组、低剂量组手术期间 HR显著下降，且高剂量组 HR下降更为明显（ P ＜00．5）。各组患者手术期间血氧饱和度（SpO2），呼吸频率（RR）均无明显变化，高剂量组、低剂量组手术期间MAP亦无明显变化（ P ＞00．5）；对照组手术期间Ramsay评分无明显变化（ P ＞00．5）。随着手术的进程，高剂量组、低剂量组Ramsay评分均显著上升（ P＜00．5），两组患者评分上升程度相比较差异无显著性（P ＞00．5）；各组麻醉均未见失败。对照组麻醉效果显著低于高剂量组、低剂量组（P ＜00．5），高剂量组、低剂量组麻醉效果相比较差异无显著性（P ＞00．5）；低剂量组不良反应发生率为261．％，与对照组232．％比较无明显差异（P ＞00．5），高剂量组不良反应发生率为391．％，显著高于低剂量组和对照组（ P ＜00．5）。【结论】右美托咪定对局部浸润麻醉下甲状腺手术患者呼吸无明显影响，且能够显著降低其因手术应激反应导致的血压、心率上升，在取得较佳镇痛、镇静效果的同时有效降低了手术的操作难度，然而大剂量右美托咪定会导致患者血流动力学受到一定影响，因此，在今后的临床应用中，应选取较小的负荷、维持剂量，在保证麻醉效果的同时保证麻醉的安全性。%Objective] To explore the effects of dexmedetomidine on blood flow dynamics and respiration in surgical thyroid patients under local infiltration anesthesia .[Methods] From September 2008 to September 2014 ,a total of 207 surgical thyroid patients under local infiltration anesthesia were randomly divided into high‐dose ,low‐dose and control groups .With fentanyl for basal anesthesia ,high and low doses of dexmedetomidine were administered .And the intraoper‐ative changes of hemodynamics and respiratory rate were compared among three groups .[Results]In control group ,mean arterial pressure (MAP) and heart rate (HR) increased significantly intraoperatively .In high‐dose and low‐dose groups , HR decreased significantly intraoperatively and it was more dramatic in high‐dose group ( P <0 0.5) .The intraoperative values of SpO2 (oxygen saturation) and respiratory rate (RR) had no significant changes in all groups .Both high‐dose and low‐dose group had no significant change in MAP ( P >0 0.5);Ramsay score had no significant change in control group ( P >0 0.5) ,but significantly increased in high‐dose and low‐dose groups ( P <0 0.5) .Yet no significant difference exis‐ted in incremental magnitude ( P >0 0.5) .There was no anesthetic failure .The anesthetic effect was significantly lower in control group than those in high‐dose and low‐dose groups ( P <0 0.5) .No significant difference in anesthetic effect exis‐ted between high‐dose and low‐dose groups ( P >0 0.5);the incidences of adverse reactions were 39 1.% ,26 1.% and 23 2.% in high‐dose ,low‐dose and control groups respectively ( P >0 0.5) .[Conclusion]Under local infiltration anesthe‐sia ,dexmedetomidine has no significant effect on respiration in surgical thyroid patients .And it can significantly reduce surgical stress response caused by rises in blood pressure and rather .With better analgesic and sedative effects ,it effec‐tively reduces operative difficulties .However ,a high dose of dexmedetomidine may alter the blood flow dynamics .Thus it is wise to choose smaller load and maintenance doses for optimal anesthetic effect and safety .