右美托咪定对琥珀胆碱肌震颤及术后肌痛的影响

摘要

目的：观察右美托咪定用于声带息肉摘除术对血流动力学的影响及预防琥珀胆碱肌震颤及术后肌痛的效果。方法选择择期行声带息肉摘除术患者60例,ASA Ⅰ~Ⅱ级,随机分为对照组( C组)和右美托咪定组( D组),D组麻醉诱导前10 min静脉给予右美托咪定1μg/kg,C组给予等量生理盐水。监测并记录给予右美托咪定前(基础值T0)、给予右美托咪定后5 min( T1)、麻醉诱导后30 s( T2)、给予琥珀胆碱后30 s( T3)、气管插管后1 min( T4)、支撑喉镜置入时( T5)、手术进行5 min( T6)、手术结束( T7)时的MAP、HR。琥珀胆碱注射后,观察肌震颤情况、气管插管条件,术后24 h肌痛指标。结果与T0时比较,C组T4~T7时MAP明显升高, HR明显增快；与C组相比,T4~T7时D组MAP明显降低,HR明显减慢(P0．05),D组肌震颤发生率与C组比较差异无统计学意义(P>0．05),但发生程度较C组显著降低(P<0．05),术后24 h C组和D组的VAS评分分别为6．54±0．37和3．48±0．45,两组比较差异有统计学意义(P<0．05)。结论术前预注右美托咪定可有效减轻声带息肉摘除术中循环波动及琥珀胆碱所致的肌震颤及术后肌痛。%Objective To observe the pretreatment effect of dexmedetomidine on succinylcholine-induced fas-ciculation and postoperative myalgia and on hemodynamic disturbances undergoing excision of vocal cord polyp. Meth-ods 60 patients with ASAⅠ~Ⅱ,undergoing excision of vacal cord polyp with general anesthesia,were randomly di-vided into Dex group( group D) and control group( group C) . Dexmedetomidine was given with 1 μg/kg within 10 min before anesthesia induction,the equal volume of normal saline was infused in group C. MAP,HR were observed at the time before dexmedetomidine infusion( T0 ) ,5 min after dexmedetomidine infusion( T1 ) ,30 s after anesthesia induction ( T2 ) ,30 s after succinylcholine injection( T3 ) ,1 min after intubation( T4 ) ,immediately after laryngoscope examination (T5),5 min after surgery(T6)and surgery completion(T7). The fasciculation and tracheal intubation condition were recorded after succinylcholine injection. VAS scores of myalgia were recorded 24 h after operation. Results compared with T0,MAP and HR in group C increased significantly at T4 ~T7(P<0. 05). Compared with group C,MAP and HR in group D significantly decreased at T4 ~T7(P<0. 05). There was no significant difference in tracheal intubation con-dition and the rate of fasciculation between the two groups,but the fasciculation severity in group D decreased signifi-cantly than in group C(P<0. 05). The VAS score of post-operative myalgia was 6. 54 ± 0. 37 in group C and 3. 48 ± 0. 45 in group D,the difference was significant(P<0. 05). Conclusion Preoperative administration of dexmedetomi-dine can maintain stable hemodynamic index and decrease the severity of succinylcholine induced fasciculation and postoperative myalgia in excision of vocal cord polyp.