右美托咪定鼻内滴注对妇科腹腔镜全麻患者拔管反应和术后寒战的影响

Effect of intranasal instillation of Dexmedetomidine on extubation reaction and postoperative shivering in gynecologic patients with general anesthesia

中文关键词: 右美托咪定  经鼻给药  寒战  拔管反应

英文关键词: Dexmedetomidine  Nasal administration  Shivering  Extubation reaction

中文摘要:

      
目的 探讨鼻内滴注右美托咪定对妇科腹腔镜全麻患者拔管反应和术后寒战的影响。方法选择2017年6月至2018年6月在我院妇科行全身麻醉下腹腔镜全子宫切除术的患者160例,年龄40～65岁,BMI 18～25 kg/m²,ASA Ⅰ或Ⅱ级。按随机数字表法分为四组,右美托咪定0.5 μg/kg组(D1组)、右美托咪定1.0 μg/kg组(D2组)、右美托咪定1.5 μg/kg组(D3组)和曲马多组(T组),每组40例。手术结束30 min前D1组、D2组和D3组分别经鼻滴注右美托咪定0.5、1.0和1.5 μg/kg;T组经鼻滴入曲马多1 mg/kg。记录患者给药前(T0)、给药后10 min(T1)、拔管即刻(T2)、拔管后3 min(T3)的HR、BP。记录拔管时患者呛咳和躁动的发生情况。记录患者在PACU期间寒战发生情况,并对镇静情况进行评分,记录患者镇静满意度。同时记录患者在PACU期间心动过缓、恶心呕吐和皮肤瘙痒等不良反应的发生情况。
结果 T1—T3时D2组和D3组HR明显慢于T组(P<0.05),T2—T3时D2组和D3组SBP和DBP明显低于T组(P<0.05)。D2组和D3组拔管时呛咳和躁动发生率明显低于D1组和T组(P<0.05)。D1组寒战发生率明显高于T组(P<0.05);D2组、D3组寒战发生率明显低于D1组(P<0.05)。D1组、D2组和D3组镇静满意率明显高于T组(P<0.05)。T组头晕、恶心呕吐和术后躁动发生率明显高于D1组、D2组和D3组(P<0.05);D3组心动过缓发生率明显高于D1组、D2组和T组。
结论 鼻内滴注右美托咪定可抑制妇科腹腔镜全麻患者的拔管反应，降低术后寒战的发生率，是一种值得推广的全身麻醉辅助用药方法。

英文摘要:

      
Objective The purpose of this study was to investigate the effect of intranasal instillation of dexmedetomidine on extubation response and postoperative shivering of patients undergoing gynecologic laparoscopic surgery in general anesthesia.
Methods One hundred and sixty patients with laparoscopic hysterectomy under general anesthesia were selected from June 2017 to June 2018 in our hospital, aged 40-65 years, BMI 18-25 kg/m², falling into ASA physical status Ⅰ-Ⅱ. They were randomly divided into four groups, 40 cases in each group. Dexmedetomidine group (group D1, D2 and D3): dexmedetomidine 0.5, 1.0 and 1.5 μg/kg were instilled by nasal infusion at thirty minutes before the end of the operation; tramadol group (group T): nasal infusion of tramadol 1 mg/kg at thirty minutes before the end of the operation. Record the heart rate and blood pressure of the patient before administration (T0), 10 minutes after administration (T1), immediate extubation (T2), and 3 minutes after extubation (T3). The incidence of cough and irritability in the patient during extubation was recorded. The incidence of chills during the PACU and the Ramsay score were recorded in four groups. Finally, the occurrence of adverse reactions such as bradycardia, nausea and vomiting were recorded.
Results HR in group D2 and group D3 were significantly slower than group T at T1-T3 (P < 0.05), and SBP and DBP in group D2 and group D3 were significantly lower than those in group T at T2 and T3 (P < 0.05). The incidence of cough and irritability in group D2 and group D3 were significantly lower than that in group T and group D1 (P < 0.05); the incidence of chills in group D1 was significantly higher than that in group T (P < 0.05). The incidence of shivering in group D3 was significantly lower than that in group D1 (P < 0.05). The sedation satisfaction rate of group D1, group D2 and group D3 were significantly higher than that of group T. The dizziness, nausea and vomiting and postoperative irritability in group T were significantly higher than those in group D1, group D2 and group D3 (P < 0.05). The incidence of bradycardia in group D3 was significantly higher than that in group T, D1 and D2.
Conclusion Intranasal infusion of dexmedetomidine can inhibit the extubation reaction of gynecological laparoscopic general anesthesia patients and reduce the incidence of postoperative chills, whitch is an adjuvant method of general anesthesia that is worth promoting.