Abstract: 【Abstract】〓Objective〓To evaluate the efficacy of different dose of dexmedetomidine on recovery period in patients undergoing breast cancer surgery. Methods〓Eighty ASA I or Ⅱ patients undergoing modified radical mastectomy under endotracheal general anesthesia were assigned into four groups(n=20,.each)...Dexmedetomidine or equal volume of normal saline was injected intravenously 30 min before the end of operation respectively. In control group (group C), 0.9% normal saline was injected intravenously and different dose of dexmedetomidine was injected intravenously in group D1, D2 and D3 respectively (0.2 μg/kg, 0.5 μg/kg and 0.8 μg/kg). Volume control ventilation was used during operation until extubation. The time of opening eyes after operation and extubation time were recorded. Riker sedation-agitation scale and Ramsay sedation scale were recorded at the time of extubation. MAP and HR were recorded at the time of extubation (T1), 2 min after extubation (T2), 5 min after extubation (T3), 10 min after extubation (T4). Results〓Compared with group C, there were no significant differences in the time of opening eyes after operation and extubation time in group D1 and group D2, while significantly prolonged in group D3 (P<0.01). The score of Riker sedation-agitation scale in most patients in group C was 5 at the time of extubation with fast HR and high MAP. Compared with group C, the incidence of agitation was significantly decreased in group D2 and D3 (P<0.01), and cardiovascular adverse reactions significantly decreased at T1-T4. The score of Ramsay sedation scale was 2-4 in group D2. There were no significant differences in HR and MAP in intra-group D2 comparison during T0-T4 (P>0.05). The percentage of Ramsay sedation scale 5-6 was 70% in group D3, indicating excessive sedation. Conclusion〓Intravenous injection of moderate dose of dexmedetomidine (0.5 μg/kg) 30 min before the end of operation can prevent agitation caused by the endotracheal tube during recovery period in patients undergoing breast cancer surgery without delayed awakening.

Key words: Dexmedetomidine, Mechanical ventilation, Recovery period, Agitation, conscious sedation

摘要： 【摘要】 目的 评价不同剂量右美托咪定对乳腺癌手术患者苏醒期的影响。方法〓选择因乳腺癌改良根治手术而行气管内插管全麻的患者80例,ASAⅠ~Ⅱ级,分成4组(n=20,每组),分别于手术结束前30 min静脉注射右美托咪定或等量生理盐水。C组(对照组)静脉注射0.9%生理盐水,D1组静脉注射右美托咪啶0.2 μg/kg,D2组静脉注射右美托咪啶0.5 μg/kg,D3组静脉注射右美托咪啶0.8 μg/kg。各组患者术中机械通气的模式采用容量控制通气持续至气管导管拔出。记录手术结束后呼之睁眼时间及拔管时间,记录气管拔管时Riker镇静、躁动评分及Ramsay镇静评分,记录拔管即刻(T1)、拔管后2 min(T2)、5 min(T3)、10 min(T4)各时点患者的平均动脉压、心率。结果〓与C组比较,D1、D2组呼之睁眼时间及拔管时间差异均无统计学意义(P>0.05),而D3组明显延长(P<0.01)。C组气管拔管时,大多患者Riker镇静及躁动评分为5分,拔管时心率明显增快、血压升高。与C组比较,D2、D3组躁动的发生率明显降低(P<0.01),T1至T4各时间点心血管不良反应明显减少。D2组患者Ramsay镇静评分为2~4分,镇静适度,T0至T4各时间点心率、血压无显著性变化。D3组患者中,Ramsay镇静评分为5~6分的患者比例为70%,呈现镇静过度的状态。结论〓在手术结束前30 min中等剂量右美托咪定(0.5 μg/kg)既可很好的预防乳腺癌手术患者苏醒期因气管导管引起的躁动,又不会导致苏醒延迟。

关键词: 右美托咪定, 机械通气, 苏醒期, 躁动, 清醒镇静