王文凯 郭文斌 陈慧琦 叶露

[摘要] 目的 探討右美托咪定对重度子痫前期剖宫产患者全身麻醉恢复期气管拔管反应的影响。 方法 选取2014年12月～2015年8月在惠州市第一妇幼保健院行全身麻醉剖宫产手术的重度子痫前期患者100例。将所有患者随机分成5组：对照组（D0组）和不同剂量右美托咪定组（D1～D4组），每组各20例。所有手术均于全麻下完成，静脉注射丙泊酚、顺苯磺酸阿曲库铵和瑞芬太尼进行麻醉诱导，术中持续泵注丙泊酚及瑞芬太尼使BIS值维持在40～50，并维持循环稳定。D1～D4组在胎儿娩出后分别静脉泵注右美托咪定0.4、0.6、0.8、1.0 μg/kg，D0组输注等容量的生理盐水作为对照，药物输注时间均为15 min。手术结束时停止输注瑞芬太尼和丙泊酚，术后带管回麻醉后监测治疗室（PACU）。监测并记录患者麻醉诱导前（T0）、拔管后1 min（T1）、拔管后5 min（T2）、拔管后10 min（T3）和拔管后15 min（T4）时的心率（HR）、收缩压（SBP）、舒张压（DBP）和血氧饱和度（SpO2）；观察患者的清醒时间、拔管时间和转出PACU时间；观察泵注右美托咪定后心血管系统不良事件的发生情况。 结果 血流动力学变化：各组间T0时的HR、SBP和DBP差异无统计学意义（P > 0.05）；与D0组比较，D1组T1～T4时的HR、SBP和DBP差异无统计学意义（P > 0.05）；D2、D3、D4组T1～T4时的HR、SBP和DBP均明显降低（P < 0.05）。与T0时比较，D0和D1组T1～T4时的HR、SBP和DBP均明显升高（P < 0.05）；D2、D3、D4组T1～T4时的HR、SBP和DBP均明显降低（P < 0.05）。苏醒时间的变化：与D0组比较，D1、D2组患者清醒时间、拔管时间和转出PACU时间差异无统计学意义（P > 0.05），D3、D4组患者清醒时间、拔管时间和转出PACU时间明显延长（P < 0.05）。所有患者输注右美托咪定后均未出现需要处理的心血管系统不良事件。 结论 术中单次静脉泵注右美托咪定0.6 μg/kg能明显抑制重度子痫前期剖宫产患者全身麻醉恢复期的气管拔管反应，且不影响麻醉恢复时间。

[关键词] 右美托咪定；重度子痫前期；剖宫产；全身麻醉

[中图分类号] R614.2 [文献标识码] A [文章编号] 1673-7210（2016）03（a）-0059-05

Effect of Dexmedetomidine on responses to extubation during recovery from general anesthesia in severe preeclampsia patients undergoing cesarean section

WANG Wenkai1 GUO Wenbin1 CHEN Huiqi2 YE Lu1

1.Department of Anesthesiology， the First Women and Children's Hospital of Huizhou， Guangdong Province， Huizhou 516007， China； 2.Department of Anesthesiology， Huiyang Area Maternity and Child Health Care Centers of Huizhou City， Guangdong Province， Huizhou 516001， China

[Abstract] Objective To evaluate the effect of Dexmedetomidine on responses to tracheal extubation during recovery from general anesthesia in severe preeclampsia patients undergoing cesarean section. Methods One hundred patients with severe preeclampsia scheduled for cesarean section under general anesthesia from December 2014 to August 2015 in the First Women and Children's Hospital of Huizhou were included in this study. All patients were randomly divided into 5 groups： control group （group D0） and different doses of Dexmedetomidine group （group D1-D4）， 20 cases in each group. Anesthesia was induced with intravenous injection of Propofol， Cisatracurium besilate and Remifentanil. Anesthesia was maintained with infusion Propofol and Remifentanil. BIS value was maintained at 40-50. Dexmedetomidine 0.4， 0.6， 0.8， 1.0 μg/kg were infused intravenously after fetal disengagement in group D1-D4， respectively， the equal volume of normal saline was administered instead in group D0 as control， infusion time was 15 min， stop infusion of Propofol and Fentanyl at the end of the surgery， and all patients were sent to PACU after operation. HR， SBP， DBP and SpO2 were monitored and recorded before anesthesia （T0） and at 1 min after extubatio （T1）， 5 min after extubatio （T2）， 10 min after extubatio （T3）， and 15 min after extubation （T4）； awake time， time for extubation and duration in PACU were observed； occurrence of adverse events of cardiovascular system after pump injection Dexmedetomidine was observed. Results Hemodynamic changes： at T0， SBP， DBP and HR had no significant differences in all groups （P > 0.05）； compared with group D0， SBP， DBP and HR had no significant differences at T1-T4 in group D1 （P > 0.05）； SBP， DBP and HR were decreased at T1-T4 in group D2， D3 and D4 （P < 0.05）. Compared with T0， SBP， DBP and HR were increased at T1-T4 in group D0 and group D1 （P < 0.05）； SBP， DBP and HR were decreased at T1-T4 in group D2， D3 and D4 （P < 0.05）. The recovery time after anesthesia： compared with D0， awake time， time for extubation and duration in PACU had no significant differences in group D1 and group D2 （P > 0.05）； awake time， time for extubation and duration in PACU were significantly prolonged in group D3 and group D4 （P < 0.05）. There were no complications of cardiovascular occured in all patients. Conclusion In severe preeclampsia patients undergoing cesarean section in general anesthesia， Dexmedetomidine 0.6 μg/kg infused intravenously can effectively inhibit the responses to endotracheal extubation during recovery， and has no effect on the time of recovery.

[Key words] Dexmedetomidine； Severe preeclampsia； Cesarean section； General anesthesia

剖宫产是重度子痫前期产妇首选的分娩方式，虽然椎管内麻醉是首选的麻醉方法，但对于存在凝血功能障碍、严重水肿导致穿刺困难、血压过高或合并脑水肿等特殊情况的产妇则必须采用全身麻醉。由于重度……