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.

参考文献

相关文章 15

[1]	李伟浩,李伟,张学民,李清乐,焦洋,张韬,蒋京军,张小明. 去分支杂交手术和传统手术治疗胸腹主动脉瘤的结果比较[J]. 北京大学学报（医学版）, 2022, 54(1): 177-181.
[2]	朱敬先,鲁胜楠,蒋艳芳,姜玲,王健全. 老年肩袖损伤手术患者术前肺功能的影响因素[J]. 北京大学学报（医学版）, 2021, 53(5): 902-906.
[3]	董文敏,王明瑞,胡浩,王起,许克新,徐涛. Allium覆膜金属输尿管支架长期留置治疗输尿管-回肠吻合口狭窄的初期临床经验及随访结果[J]. 北京大学学报（医学版）, 2020, 52(4): 637-641.
[4]	高健,胡立宝,陈尘,郅新,徐涛. 经皮肾镜去石术后出血的介入治疗[J]. 北京大学学报（医学版）, 2020, 52(4): 667-671.
[5]	白珊珊,莫思怡,徐啸翔,刘云,谢秋菲,曹烨. 大鼠咬合干扰致口颌面痛敏的自我赏罚实验行为学特点[J]. 北京大学学报（医学版）, 2020, 52(1): 51-57.
[6]	马凯,曲星珂,许清泉,熊六林,叶雄俊,安立哲,陈伟男,黄晓波. 肾移植术后移植肾输尿管膀胱吻合口狭窄的腔内治疗:13例报道[J]. 北京大学学报（医学版）, 2019, 51(6): 1155-1158.
[7]	孙文强,赵舟,高卿,韩增强,杨威,廉波,刘刚,陈生龙,陈彧. 非体外循环冠状动脉旁路移植术中桥血管血流对术后近中期预后的影响[J]. 北京大学学报（医学版）, 2019, 51(5): 851-855.
[8]	刘鲲鹏,王宝宁,申琰琰,李卫霞,李昭,姚兰. 胸部硬膜外给予利多卡因对双腔气管插管患者血流动力学和唤醒水平的影响[J]. 北京大学学报（医学版）, 2019, 51(4): 742-747.
[9]	徐稼轩,王宏志,董军,陈小杰,杨勇,陈仁雄,王国栋. 食管癌术后急性肺损伤/急性呼吸窘迫综合征的危险因素分析[J]. 北京大学学报（医学版）, 2018, 50(6): 1057-1062.
[10]	高玲,刘云,杨旭东. 鼻喷右美托咪定在儿童口腔门诊全身麻醉前的镇静效果[J]. 北京大学学报（医学版）, 2018, 50(6): 1078-1082.
[11]	李岩，王辉，邓莹，姚瑶，李民. 静脉输注右美托咪定对臂丛阻滞效果的随机对照研究[J]. 北京大学学报(医学版), 2018, 50(5): 845-849.
[12]	李旭, 李奉龙, 鲁谊, 朱以明, 郭斯翊, 李屹钧, 姜春岩. 锁定钢板治疗非骨质疏松性复杂肱骨近端骨折的中期临床及影像学随访研究[J]. 北京大学学报(医学版), 2017, 49(5): 855-860.
[13]	兰轲，杨文博，张晓威，白文俊，李清，徐涛. 氟比洛芬酯在经直肠超声引导前列腺穿刺疼痛控制中的应用[J]. 北京大学学报(医学版), 2017, 49(4): 643-647.
[14]	邓莹，姜天乐，杨晓霞，李民，王军，郭向阳. 连续股神经阻滞联合关节周围浸润镇痛对全膝关节置换术后关节早期功能恢复的影响[J]. 北京大学学报(医学版), 2017, 49(1): 137-141.
[15]	朱惠，朱蓉，邓肇达，封昱辰，沈海丽. 离子型谷氨酸受体拮抗剂MK-801和NBQX对胶原诱导型关节炎大鼠的镇痛作用[J]. 北京大学学报(医学版), 2016, 48(6): 977-981.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed