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岭南现代临床外科 ›› 2017, Vol. 17 ›› Issue (03): 337-340.DOI: 10.3969/j.issn.1009-976X.2017.03.021

• 论著与临床研究 • 上一篇    下一篇

右美托咪定对抗依托咪酯致甲状腺手术全麻苏醒期患者肌阵挛的效果评价

关宏锐 刘历威 梁少英 杨莉 马志佳   

  1. 开平市中心医院
  • 通讯作者: 马志佳

Effect of dexmedetomidine on reducing the myoclonus rates caused by etomidate for patients with thyroid surgery anesthesia awakening period

GUAN Hongrui ,LIU Liwei ,LIANG Shaoying , YANG Li ,MA Zhijia   

  1. 1 Department of Anesthesiolosy,Kaiping Central Hospital,Kaiping,Guangdong 529300, China; 2 The Second Clinical Medical College, Southern Medical University, Guangdong 510315,China.
  • Online:2017-06-20 Published:2017-06-20
  • Contact: MA Zhijia

摘要:

目的 观察右美托咪定对抗依托咪酯致甲状腺手术全麻苏醒期患者肌阵挛的效评价。方法 选择择期甲状腺手术患60ASA~20~44分为观察组及对照组各30两组均采用静脉注射咪达唑0.03mg·kg-1芬太0.003mg·kg-1依托咪0.3mg·kg-1全麻诱导插管随后持续泵注依托咪8μg·kg-1min-1和瑞芬太0.2μg·kg-1min-1作麻醉维持察组在此基础上给予分别静注右美托咪4μg·kg-1·h-14μg·mL-1而对照组给予等1mL/kg·h生理盐记录诱导T1气管插管T2手术完T3清醒拔管T4的体温HR平均动脉MAP以及苏醒后肌阵挛的发生情并记录肌阵挛的严重程记录中追加七氟醚用量以及术中和术后不良反应发生情结果 T2~T4各时点两组HRMAP的差异有统计学意P<0.05观察组患者术后躁动及术后寒颤的发生率显著低于对照P=0.0460.023观察组分别有2例在诱导期及苏醒期出现肌阵挛而对照组为9例及8例,两组例数构成有统计学差P=0.0210.039在程度的比较方面观察组苏醒期出现肌阵挛的2例分别123级阵挛而对照组32级阵挛为主两组构成均有统计学差P=0.003但两组肌阵挛所致的严重并发症无统计学差P=0.154。观察组的苏醒时间时间定向恢复时间较对组有明显的P<0.05结论 右美咪定能有效托咪酯致甲状腺手术全麻苏醒期肌阵挛的发维持血流动力学稳可缩短苏醒拔管力恢复时间并减少不良反应发生

关键词: 右美托咪定, 肌阵挛, 甲状腺手术, 全身麻醉, 依托咪酯

Abstract:

 Objective To observe the effect of dexmedetomidine on reducing the myoclonus rates caused by etomidate for patients with thyroid surgery anesthesia awakening period. Methods Sixty patients with thyroid surgeryASA I to II, 20 to 44 years oldwere divided into the observation groupn= 30and the control groupn=30. The patients in two groups were treated with intravenous midazolam 0.03 mg · kg- 1, fentanyl0.003 mg · kg- 1, etomidate0.3 mg · kg- 1for general anesthesia induction intubation, and both were followed by continuous infusion of etomidate8 μg/kg- 1 · min- 1and remifent-anil0.2 μg · kg-1 · min-1for maintaining anesthesia. On this basis, the observation group were given in-travenous infusion of dexmedetomidine4 μg · kg- 1 · h- 1, 4 μg · ml- 1, while the control group was given the same dose of normal saline1 ml · kg- 1 · h- 1. The temperature before inductionT1, after tracheal intubationT2, the end of operationT3, awake after extubationT4, heart rateHR, mean arte-rial pressureMAPand the occurrence of myoclonus after recovery and the severity of myoclonus were recorded. The intraoperative additional amount of sevoflurane, intraoperative and postoperative adverse reactions were also recorded. Results There were significant differences between HR and MAP T2- T4 at each time point in the two groupsall P values < 0.05the incidence of restlessness and postopera-tive shivering in the observation group after surgery was significantly lower than the control group P=0.046 and 0.023. There were 2 and 9 patients who suffered from myoclonus occurring in the induced pe-riod in the observation and control group, respectivelyP=0.021, and 2 and 8 in the recovery period, respectivelyP=0.039. About the severity of comparison, 2 cases in observation group were 1 and 2, no grade 3, while the control group was treated mainly with 3 and 2 grade myoclonus. The total numberof cases and clonus grade in two group composition were statistically significant P=0.003. Moreover, the recovery time, extubation time and the recovery time of the directional force in the observation group were significantly shorter than those in the control groupall P<0.05. Conclusion Dexmedetomidine can effectively reducing the myoclonus rates caused by etomidate for patients with thyroid surgery anes-thesia awakening period, maintain hemodynamic stability, shorten the recovery time, extubation, direc-tional force recovery time and reduce the adverse reactions.

Key words: myoclonus, thyroid surgery, dexmedetomidine, general anesthesia, etomidate

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