右美托咪定复合丙泊酚全麻对骨科腰椎手术患者术后恢复的影响

doi:10.3969/j.issn.1671-167X.2016.03.026

摘要/Abstract

摘要：

目的：评价右美托咪定（dexmedetomidine，DEX）复合丙泊酚全麻对骨科腰椎手术患者术后恢复的影响。方法：选择北京大学第一医院2014年1月至5月择期全麻下行腰椎管减压、椎弓根钉内固定植骨融合术患者60例，美国麻醉医师协会（American Society of Anesthesiologists，ASA）分级Ⅰ～Ⅱ级，年龄18～65岁，按随机数字表将患者分为DEX组和对照组，每组30例。两组患者均以咪达唑仑0.03 mg/kg、丙泊酚1～2 mg/kg、舒芬太尼效应室靶控浓度0.5 μg/L和顺式阿曲库铵0.2 mg/kg诱导插管，术中以吸入50%（体积分数）笑气、靶控输注丙泊酚和舒芬太尼维持麻醉。DEX组麻醉诱导前静脉泵入DEX 0.5 μg/kg（10 min），术中以0.2 μg/(kg·h)持续输注；对照组静脉泵入等量生理盐水。两组术后均采用0.5 g/L吗啡静脉自控镇痛，记录两组患者麻醉诱导、术后拔管及恢复时的平均动脉压（mean arterial pressure，MAP）、心率（heart rate,HR），术毕停药后的苏醒时间、拔管时间和定向力恢复时间，术后1 h在麻醉后恢复室（post-anesthesia care unit，PACU）的Ramsay评分和苏醒期躁动RSAS评分，术后48 h内的疼痛视觉模拟评分（visual analogue scale，VAS）、自控镇痛吗啡用量及不良反应发生率。结果：两组患者术后苏醒时间、拔管时间和定向力恢复时间差异均无统计学意义。两组患者PACU停留期间的Ramsay评分及苏醒期躁动RSAS评分差异均无统计学意义。DEX组术后48 h内各时点的VAS评分均显著低于对照组（P<0.05），术后2 h和6 h的吗啡累计用量小于对照组（P<0.05）。与对照组比较，DEX组于DEX负荷量输注结束时HR显著减慢，MAP明显降低（P<0.05），于诱导插管、术后拔管各时点及PACU 10 min时HR显著减慢（P<0.05），于术后拔管各时点和PACU期间MAP显著降低（P<0.05）。与对照组相比，DEX组于DEX输注结束时HR和MAP均显著降低。DEX组于术中诱导插管开始至拔管后各时点及PACU停留10 min时的HR显著低于对照组（P<0.05）；在拔管后各时点及PACU期间，DEX组的MAP显著低于对照组（P<0.05）。结论：DEX复合丙泊酚全麻用于骨科腰椎手术时，可改善术后镇痛效果，节俭术后早期吗啡用量，并减少术后恶心和呕吐发生率。

关键词: 右美托咪定, 麻醉,全身, 疼痛, 手术后, 麻醉恢复期, 脊柱融合术

Abstract:

Objective：To evaluate the effect of intraoperative dexmedetomidine (DEX) infusion during propofol intravenous anesthesia on postoperative recovery after major spinal surgery. Methods:Sixty patients aged 18 to 65 (American Society of Anesthesiologists, ASA Ⅰ-Ⅱ), scheduled for spinal surgery from January 2014 to May 2014 were randomized into two groups. The DEX group (n=30) received 0.5 μg/kg of DEX ten minutes before anesthesic induction, followed by an infusion of DEX at 0.2 μg/(kg·h) intraoperatively and the control group (n=30) was given identical amounts of normal saline. At the end of surgery, the patients of both groups received patient-controlled intravenous analgesia (PCIA) with morphine 0.5 mg/h (1 mg demand dose and 8 min lockout). Heart rate and mean arterial pressure (MAP) were continually monitored during operation and in the post-anesthesia care unit (PACU). The propofol and sufentanil consumptions during operation and the morphine consumption 48 h after surgery were recorded. The time for recovery and extubation were recorded. The followed-up evaluations were performed to assess Ramsay scores, visual analogue scale (VAS) pain scores as well as side effects in PACU and 48 h after surgery. Results:Heart rate of DEX group was lower than that of control group after intubation and extubation and in PACU 10 min (P<0.05). MAP was lower in DEX group than that in control group after extubation and in PACU (P<0.05). Compared with control group, the propofol consumption during anesthesic induction, the sufentanil consumption during operation and the cumulative consumption of morphine 2 h and 6 h after surgery were decreased (P<0.05). There were no differences between the two groups as to the time for recovery or extubation. Compared with control group, the VAS pain scores were significantly decreased (P<0.01), the incidence of postoperative nausea and vomiting in DEX group were significantly decreased (P<0.05) 48 h after surgery. Conclusion: Intraoperative infusion of DEX improved quality of recovery, provided good analgesia, and decreased morphine use and the incidence of postoperative nausea and vomiting after major spinal surgery.

Key words: Dexmedetomidine, Anesthesia, general, pain, postoperative, Analgesia recovery period, Spinal fusion

中图分类号:

R614.2

李炳艳，耿志宇，王东信. 右美托咪定复合丙泊酚全麻对骨科腰椎手术患者术后恢复的影响[J]. 北京大学学报(医学版), 2016, 48(3): 529-533.

LI Bing-yan, GENG Zhi-yu, WANG Dong-xin. Effect of dexmedetomidine infusion on postoperative recovery for patients undergoing major spinal surgery during propofol anesthesia[J]. Journal of Peking University(Health Sciences), 2016, 48(3): 529-533.

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