不同剂量右美托咪定对脑功能区肿瘤 手术患者苏醒质量的影响

Effect of different dosages of Dexmedetomidine on awakening quality of patients with brain functional resection

摘要:

目的 分析不同剂量右美托咪定（Dex）对脑功能区肿瘤切除手术患者苏醒质量的影响。 方法 选取2016 年4 月1 日-2017 年5 月31 日在该院神经外科择期行脑功能区肿瘤切除手术患者88 例， 按随机数字表法，将患者分为4 组：Dex1 组、Dex2 组、Dex3 组和对照组，每组22 例。Dex1 组、Dex2 组、 Dex3 组分别于手术结束前15 min 按1.0、1.5 和2.0μg/kg Dex 行肌内注射，对照组则行等量生理盐水肌内注 射。观察并记录不同时间的舒张压、有创动脉收缩压、心率和血氧饱和度；记录各组患者自主呼吸恢复、唤 醒及拔管时间；比较各组患者不同时刻的镇静和镇痛评分，以及苏醒期的不良反应。结果 4 组患者自主呼 吸恢复时间、唤醒时间及拔管时间比较，差异无统计学意义（P >0.05）；拔管后5 和15 min，Dex 组患者的镇 静、镇痛评分与对照组比较，差异有统计学意义（P <0.05）；Dex2 组、Dex3 组患者拔管时血浆皮质醇水平低 于对照组（P <0.05）。Dex3 组苏醒期躁动、心动过速及血压升高的发生率较Dex1 组和对照组低（P <0.05）。 结论 术毕前15 min 肌内注射1.5μg/kg Dex 可使脑功能区手术患者苏醒期的血流动力学更稳定，减轻苏醒 期应激反应，有效改善苏醒质量。

Abstract:

Objective To study the effect of different dosages of Dexmedetomidine (Dex) on the awakening quality of the patients receiving resection of tumors in the brain functional areas. Methods Eighty-eight patients with brain functional area tumors, who underwent elective surgery from April 1, 2016 to May 31, 2017, were randomly divided into four groups: Dex1 group, Dex2 group, Dex3 group and control group with 22 in each group. The patients in the Dex1, Dex2 and Dex3 groups had intramuscular injection of 1.0, 1.5 and 2.0 g/kg Dex respectively at 15 min before the end of surgery, while the patients in the control group had intramuscular injection of the same amount of saline. The systolic pressure, diastolic pressure, heart rate, pulse and oxygen saturation at different time were compared. The spontaneous breathing recovery time, awakening time and extubation time of each group were recorded. The sedation and analgesic scores, and adverse reactions occurred during the recovery period were compared. Results The time of spontaneous breathing recovery, awakening time or extubation time was not significantly different among the 4 groups (P > 0.05). The sedation and analgesic scores in the Dex groups were significantly different from those in the control group at 5 and 15 min after extubation (P < 0.05). The plasma cortisol levels of the Dex 2 and Dex 3 groups were significantly lower than that of the control group at the time of extubation (P < 0.05). The levels of Dex 2 and Dex 3 were significantly lower (P < 0.05). The incidences of recovery period agitation, elevation of blood pressure and tachycardia in the Dex 3 group were significantly lower than those in the Dex1 and control groups (P < 0.05). Conclusions Intramuscular injection of 1.5 μg/kg Dex at 15 min before the end of surgery could promote the stabilization of hemodynamics during the awakening period in the patients receiving operation in the functional areas of the brain, significantly reduce the stress response in the awakening phase, effectively improve the awakening quality of the patients, suggesting that this dosage is more appropriate.