全髋置换术后应用右美托咪定对患者麻醉苏醒期的影响

摘要

Objective To investigate the effects of dexmedetomidine on the recovery period of patients after total hip replacement.Methods A total of 40 patients who were scheduled to undergo total hip replacement were randomly divided into a dexmedetomidine group (Group D) and a normal saline group (Group N) (n =20).All the patients were subjected to general anesthesia induction and maintenance,before connection with a sufentanil analgesia pump and being sent to a post anesthesia care unit (PACU) with intubation.Then they were treated with the same dose of 0.5 μg · kg-1 · h-1 dexmedetomidine and normal saline at the same rate until extubation.Both groups were compared for heart rate (HR),systolic and diastolic blood pressures (SBP and DBP),and oxyhemoglobin saturation (SpO2) before anesthesia (T1),when entry in PACU (T2),at the extubation (T3),5 min after extubation (T4),10 min after extubation (T5) and 20 min after extubation (T6).The scores of numeric rating scale (NRS) and the Riker sedation-agitation scale,and the Steward awakening score were evaluated 20 min after extubation.The corresponding indexes and adverse reactions in the recovery period,and patients' satisfaction about pain management were observed.Both groups were compared for the time of extubation and PACU stay.Results There were no statistical differences in age,gender,body weight,operation time and blood loss during operation between the two group (P ＞ 0.05).Group N presented lower HR,SBP and DBP at T2 than those at T1 (P ＜ 0.05),and higher HR,SBP and DBP at T3 than those at T1 (P ＜ 0.05).Group D showed lower HR,SBP and DBP at T2 than those at T1 (P ＜ 0.05).The SBP and DBP were remarkably reduced in Group D at T3 and T4,compared with Group N (P ＜ 0.05).The HR of Group D was lower at T3,T4 and T5 than that of Group N (P ＜ 0.05).No differences were found as to SpO2 at various time points between the two groups (P ＞ 0.05).Group N produced higher NRS scores and SAS scores at T6 than Group D (P ＜ 0.05).There were no differences as to the Steward awakening score,the time of extubation and PACU stay between the two groups (P ＞ 0.05).In the recovery period,Group N presented higher incidences of nausea,vomiting,dizziness and drowsiness than Group D (P ＜0.05),while patients in Group D reported better satisfaction about pain management than those in Group N (P ＜ 0.05).Conclusions Administration of dexmedetomidine after total hip replacement can guarantee stable hemodynamics in the recovery period,reduce adverse reactions like restlessness,and improve the satisfaction of patients about pain management after operation.%目的 研究全髋置换术后应用右美托咪定对患者麻醉苏醒期的影响.方法 选择40例择期行单侧全髋置换手术的患者,按随机数字表法分为2组,分别为右美托咪定组(D组)和生理盐水组(N组),每组20例.2组患者均给予标准的全麻诱导、维持程序,术毕连接舒芬太尼静脉镇痛泵,不拔除气管导管,送入麻醉后恢复室(PACU).于入恢复室后即刻分别由静脉泵入右美托咪定0.5 μg·kg-1·h-1和同等剂量、速率的生理盐水至气管导管拔除.观察2组患者在麻醉前(T1)、入PACU时(T2)、拔管时(T3)、拔管后5 min (T4)、拔管后10 min(T5)、拔管后20 min (T6)的心率(HR)、收缩压(SBP)、舒张压(DBP)、脉搏氧饱和度(SpO2).评估拔管后20 min时各组患者的疼痛评分(NRS)、Riker镇静和躁动评分(SAS)、Steward评分,观察苏醒期相关指标和不良反应并调查患者对于疼痛控制的满意度,比较2组患者的拔管时间和在PACU的停留时间.结果 2组患者在年龄、性别、体重、手术时间、术中出血量方面的差异均无统计学意义(P＞0.05).N组T2的HR、SBP、DBP均低于T1,T3的HR、SBP、DBP均高于T1,差异均有统计学意义(P＜0.05).D组T2的HR、SBP、DBP均低于T1(P ＜0.05);D组T3、T4的SBP、DBP均低于N组,差异有统计学意义(P＜0.05);T3、T4、T5的HR均低于N组,差异有统计学意义(P＜0.05);2组各时间点SpO2的差异均无统计学意义(P＞0.05).N组T6的NRS评分和SAS均高于D组(P＜0.05),2组Steward评分的差异无统计学意义(P＞0.05).2组的拔管时间、PACU停留时间比较差异均无统计学意义(P＞0.05).苏醒期N组恶心呕吐、头晕、嗜睡的发生率均高于D组(P＜0.05),且D组患者对疼痛控制的满意度高于N组(P＜0.05).结论 全髋置换术后应用右美托咪定可保持患者苏醒期的血流动力学稳定,有效减少苏醒期躁动等不良反应的发生,且提高了患者对术后疼痛控制的满意度.