右美托咪定、地佐辛与曲马多对全麻苏醒恢复质量的影响

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摘要目的探讨右美托咪定、地佐辛与曲马多对七氟烷麻醉腹腔镜肾切除术患者苏醒期寒战、躁动及拔管期间血流动力学变化的影响。方法选取我院2016年1～10月收治的ASAⅠ～Ⅱ级择期行肾切除术的160例肾癌患者，应用随机数字表法随机分为右美托咪定（Dex）组、地佐辛（Dez）组、曲马多（Tra）组与0.9%氯化钠溶液（Con）组，每组 40 例。各组患者均给予七氟烷（≥0.6 MAC）持续吸入，瑞芬太尼 0.15～0.30 μg/（kg·min）持续泵注，维持麻醉。Dex、Dez、Tra三组患者分别在手术结束前30 min给予右美托咪定1 μg/kg、地佐辛0.1 mg/kg及曲马多1 mg/kg，缓慢静脉泵注，Con组给予等容量0.9%氯化钠液体，手术缝皮时停止麻醉，观察记录四组患者术后的寒战评分、呼吸恢复时间、呼之睁眼时间、拔管时间以及各时间点及拔管后1、5、10、20、30 min的镇静躁动（Riker）评分、镇静（Rameasy）评分、HR、MAP、SpO2。结果Dex、Dez、Tra 三组患者的寒战发生率分别为 32.5%、32.5%与 7.5%，显著低于 Con 组的 57.5%（P＜0.05），Tra组的寒战发生率显著低于 Dex与 Dez组（P＜0.05）。 Tra、Dez、Dex组的躁动发生率分别为40.0%、12.5%、10.0%，显著低于Con组的70.0%（P＜0.05），Tra组的躁动发生率显著高于Dex与Dez组（P＜0.05）。 Dex、Dez、Tra 组患者 T3、T4、T5时的 HR、MAP 水平显著低于 Con 组（P＜0.05），Con 组 T3、T4、T5时的HR、MBP 水平显著高于 T1（P＜0.05）。Dex、Dez组患者 T3、T4时的 HR、MAP 水平显著低于 Tra 组（P＜0.05）。结论右美托咪定1 μg/kg、地佐辛0.1 mg/kg、曲马多1 mg/kg手术结束前30 min静脉输注，可以有效预防七氟烷麻醉腹腔镜肾切除术患者术后寒战及躁动的发生，降低拔管期血流动力学的波动。

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	韩明杰
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关键词 ：右美托咪定, 地佐辛, 曲马多, 寒战, 躁动, 血流动力学变化

Abstract：

ObjectiveTo explore the influence of Dexmedetomidine,Dezocine and Tramadol on postoperative shivering and emergence agitation in patients anesthetized with Sevoflurane undergoing laparoscopic nephrectomy,and haemodynamic stability during extubation.Methods160 patients with kidney cancer in our hospital,American Society of Anesthesiologists(ASA)Ⅰ-Ⅱ,undergoing laparoscopic nephrectomy from January to October in 2016 were selected and divided into the Dexmedetomidine(Dex)group,the Dezocine(Dez)group,the Tramadol(Tra)group,the 0.9%Sodium Chloride Solution(Con)group according to the random number table method,40 cases in each group.All patients were anesthetized with Sevoflurane (≥0.6 MAC)supplemented by Remifentanil 0.15-0.30 μg/(kg·min)after anesthesia induction.The Dex group received 1 mg/kg of Dexmedetomidine,the Dez group received 0.1 mg/kg of Dezocine,the Tra group received 1 mg/kg of Tramadol,the Con group received 0.9%normal saline 30 minutes before the end of surgery.The incidence of postoperative shivering and emergence agitation,the time of autonomous respiration,eye opening,extubation and the mean arterial pressure(MAP),hear rate(HR),Riker Sedation-Agitation Scale and Rameasy sedation score,SpO2were compared at the last three time points and 1,5,10,20,30 min after extubation.ResultsThe incidence of shivering in the three groups of Dex,Dez and Tra were 32.5%,32.5%and 7.5%respectively,which was significantly lower than that of the Con group (57.5%)(P＜0.05),the incidence of shivering in the Tra group was significantly lower than that in the Dex and Dez group (P＜0.05).The incidence of emergence agitation in the Tra,Dez and Dex groups were 40.0%,12.5%and 10.0%,respectively,which was significantly lower than that in the Con group(70.0%)(P＜0.05).The incidence of emergence agitation in the Tra group was significantly higher than that in the Dex and Dez group (P＜0.05).The levels of HR and MAP in the Dex,Dez,and Tra group at T3,T4and T5were significantly lower than those of the Con group (P＜0.05).The level of HR and MBP at T3,T4,and T5in the Con group was significantly higher than that at T1(P＜0.05).The level of HR and MAP at T3and T4in the Dex and Dez group was significantly lower than that in the Tra group (P＜0.05).ConclusionAdministration of Dexmedetomidine (1 μg/kg),Dezocine (0.1 mg/kg)or Tramadol(1 mg/kg)at 30 minutes before the end of surgery can reduces postoperative shivering and emergence agitation,and attenuates the hemodynamic response to extubation in patients receiving Sevoflurane anesthesia for laparoscopic nephrectomy.

Key words： Dexmedetomidine Dezocine Tramadol Shivering Emergence Agitation Hemodynamic changes

引用本文:

韩明杰;叶林阳. 右美托咪定、地佐辛与曲马多对全麻苏醒恢复质量的影响[J]. 中国当代医药, 2018, 25(2): 104-108.
HAN Ming-jie;YE Lin-yang. Influence of Dexmedetomidine,Dezocine and Tramadol on the general anesthesia recovery quality. 中国当代医药, 2018, 25(2): 104-108.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2018/V25/I2/104

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