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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
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创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
党淼,吴媛媛.右美托咪定复合瑞芬太尼在甲状腺手术中的应用[J].中华老年多器官疾病杂志,2020,19(8):594~598
右美托咪定复合瑞芬太尼在甲状腺手术中的应用
Application of dexmetiomidine combined with remifentanil in thyroid surgery
投稿时间:2019-08-10  
DOI:10.11915/j.issn.1671-5403.2020.08.139
中文关键词:  右美托咪定;镇静;甲状腺手术;血流动力学
英文关键词:dexmetomide; sedation; thyroid surgery; hemodynamics Corresponding author:DANG Miao, E-mail:maggie2119@163.com〖FL
基金项目:
作者单位E-mail
党淼 锦州医科大学 附属第三医院麻醉科,辽宁 锦州 121000 maggie2119@163.comapplication 
吴媛媛 锦州医科大学 附属第一医院麻醉科,辽宁 锦州 121000 maggie2119@163.comapplication 
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中文摘要:
      目的 研究右美托咪定(DEX)复合瑞芬太尼在甲状腺手术中血流动力学变化、临床麻醉效果和患者的术后舒适度与满意度。方法 选取2018年12月至2019年4月期间在锦州医科大学附属第三医院全麻下行甲状腺手术的患者50例,应用随机数表法分为2组:DEX组和丙泊酚组,每组25例。DEX组:DEX+瑞芬太尼;丙泊酚组:丙泊酚+瑞芬太尼。记录入室时(T0)、插管后(T1)、切皮时(T2)、手术开始10min(T3)、术毕(T4)、睁眼时(T5)、拔管(T6)、离开麻醉后检测治疗室(PACU)时(T7)的收缩压(SBP)、舒张压(DBP)、心率、经皮测血氧饱和度(SPO2)。记录患者睁眼时间、拔管时间、定向力恢复时间、拔管后10min的警觉/镇静量表(OAA/S)评分、PACU Aldrate评分系统≥9的时间、Steward苏醒评分、术后1d的视觉模拟量表(VAS)评分。观察拔管时的不良反应。采用SPSS21.0进行统计分析。根据数据类型,分别采用t检验或χ2检验进行组间比较。结果 50例样本中均无术中知晓出现。2组患者在T2~7时刻的SBP、DBP、心率的差异具有统计学意义(P<0.05),在T5和T7时刻的SPO2的差异具有统计学意义(P<0.05)。与丙泊酚组比较,DEX组的睁眼时间[(1.08±0.81)和(6.56±1.87)min]、拔管时间[(2.04±1.10)和(8.48±1.81)min]、定向力恢复时间[(1.56±0.87)和(10.32±2.93)min]、 PACU Aldrate评分≥9的时间[(5.28±1.10)和(12.48±4.44)min]更短,术后发生躁动(0和3例)、呛咳(2和11例)、呼吸抑制(0和10例)者较丙泊酚组更少,OAA/S评分[(1.12±0.33)和(2.12±0.67)]、VAS评分[(5.20±0.77)和(2.72±1.10)]更低,而苏醒评分[(4.12±0.73)和(5.80±0.41)]更高,差异均具有统计学意义(P<0.05)。结论 与丙泊酚组比较,DEX在甲状腺全麻手术中麻醉期间的血流动力学更平稳,对于改善苏醒质量更有优势。
英文摘要:
      Objective To investigate the effect of dexmedetomidine (DEX) combined with remifentanil on hemodynamic changes, clinical anesthesia efficacy and postoperative comfort in patients undergoing thyroid surgery. Methods Fifty patients undergoing thyroid surgery under general anesthesia in Third Affiliated Hospital of Jinzhou Medical University from December 2018 to April 2019 were recruited in this study. They were randomly divided into DEX group (DEX+remifentanil, n=25) and propofol group (propofol+remifentanil, n=25). The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and blood oxygen saturation (SPO2) were recorded at the time of entry (T0), intubation (T1), skin incision (T2), beginning (T3) and end of operation (T4), eye opening (T5), extubation (T6), and leaving the post-anesthesia care unit (PACU, T7). The score of observer′s assessment of alertness/sedation scale (OAA/S), time to PACU Aldrate score more than 9 points, and Steward recovery score at T5, T6, time of orientation recovery and 10min after extubation, and the score of visual analog scale (VAS) on the first day post-operatively were investigated and recorded. The adverse reactions after extubation were observed. SPSS statistics 21.0 was used for data analysis. According to different data type, t test or χ2 test was used for data comparison between two groups. Results No intraoperative awareness was observed among the 50 patients. There were significant differences in SBP, DBP, and HR from T2 to T7 (P<0.05), and in SPO2 at T5 and T7 in the 2 groups (P<0.05). DEX group had obviously shorter T5 [(1.08±0.81) vs (6.56±1.87)min], T6 [(2.04±1.10) vs (8.48±1.81)min], time of orientation recovery [(1.56±0.87) vs (10.32±2.93)min], time to PACU Aldrate score more than 9 points [(5.28±1.10) vs (12.48±4.44)min], statistically less cases of restlessness (0 vs 3 cases), cough (2 vs 11 cases), respiratory depression (0 vs 10 cases), remarkably lower scores of OAA/S [(1.12±0.33) vs (2.12±0.67)] and VAS[(5.20±0.77) vs (2.72±1.10)], and notably higher score of awareness [(4.12±0.73) vs (5.80±0.41)] when compared with propofol group(all P<0.05). Conclusion Compared with propofol treatment, DEX treatment causes more stable hemodynamics during anesthesia maintenance, and has better advantages in improvement of the quality of recovery.
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