摘要目的 评价右美托咪定、地佐辛单独或复合用药对开胸术患者苏醒期躁动的影响.方法 择期拟行开胸术患者80例,ASA分级Ⅰ或Ⅱ级,年龄18～64岁,体重48～75 kg,采用随机数字表法,将其分为4组(n=20):对照组(C组)、右美托咪定组(DEX组)、地佐辛组(DEZ组)和右美托咪定+地佐辛组(DEX+ DEZ组).DEX组于麻醉诱导前15 min时静脉注射右美托咪定0.5 μg/kg,继静脉输注0.4 μg·kg-1·h-1至关胸开始,DEZ组于关胸开始静脉注射地佐辛0.1 mg/kg,DEX+ DEZ组于麻醉诱导前15 min时静脉注射右美托咪定0.5 μg/kg,继静脉输注0.4 μg· kg-1 ·h-1至关胸开始,静脉注射地佐辛0ˉ1 mg/kg,C组麻醉诱导前15 min开始至关胸开始时给予等容量生理盐水.每组缝皮开始时静脉注射氟比洛芬酯50 mg.分别于麻醉诱导前10 min (T1)、关胸完毕缝皮前(T2)、拔除气管导管即刻(T3)、拔除气管导管后15 min(T4)时抽取肘静脉血样,采用ELISA法测定血浆C-反应蛋白(CRP)、TNF-α和IL-10的浓度,记录患者苏醒期躁动等不良反应的发生情况,采用Ramsay评分评价镇静程度.结果 与C组比较,DEX组、DEZ组和DEX+ DEZ组T2-4时血浆CRP、TNF-α浓度降低,IL-10浓度升高,TNF-α/IL-10比值降低,躁动程度及发生率降低,镇静评分升高(P＜0.05)；与DEX组和DEZ组比较,DEX+ DEZ组T2-4时血浆CRP、TNF-α浓度降低,IL-10浓度升高,TNF-α/IL-10比值降低,躁动程度及发生率降低(P＜0.05).四组患者苏醒期均无低血压、心动过缓、呼吸抑制、恶心呕吐等发生.结论 右美托咪定、地佐辛单独或复合用药均可降低开胸术患者苏醒期躁动程度及发生,同时可抑制炎性反应,且二者复合较单独用药效果更佳.

abstractsObjective To evaluate the effects of dexmedetomidine or dezocine alone or the combination of the two agents on the emergence agitation in patients undergoing thoracic surgery.Methods Eighty ASA Ⅰ or Ⅱ patients,aged 18-64 yr,weighing 48-75 kg,scheduled for elective thoracic surgery under general anesthesia,were randomly divided into 4 groups (n =20 each):control group (group C),dexmedetomidine group (group DEX),dezocine group (group DEZ) and dexmedetomidine + dezocine group (group DEX + DEZ).In group DEX,dexmedetomidine 0.5 μg/kg was injected intravenously at 15 min before induction of anesthesia,followed by continuous infusion of dexmedetomidine at 0.4 μg· kg-1 · h-1 until beginning of chest closure.Dezocine 0.1 mg/kg was injected intravenously after beginning of chest closure in group DEZ.In group DEX + DEZ,dexmedetomidine 0.5 μg/kg was injected intravenously at 15 min before induction of anesthesia,followed by continuous infusion of dexmedetomidine at 0.4 μg·kg-1 ·h-1 until beginning of chest closure and then dezocine 0.1 mg/kg was injected intravenously.While the equal volume of normal saline was given instead in group C.Flurbiprofen axetil 50 mg was injected intravenously at beginning of skin closure in each group.Venous blood samples were collected for determination of plasma C-reactive protein (CRP),TNF-α and IL-10 levels at 10 min before induction of anesthesia (T1),before skin closure (T2),immediately after extubation (T3) and 15 min after extubation (T4).Side effects such as agitation during emergence from anesthesia were recorded.Sedation was assessed using Ramsay score.Results Compared with group C,the levels of plasma CRP and TNF-α at T2-4 and ratio of TNF-α/IL-10 were significantly decreased,the levels of IL-10 were increased at T2-4,the degree and incidence of agitation were decreased,and Ramsay score was increased in the other three groups (P ＜ 0.05).Compared with groups DEX and DEZ,the levels of plasma CRP and TNF-α at T2_4 and ratio of TNF-α/IL-10 were significantly decreased,the levels of IL-10 were increased at T2-4,and the degree and incidence of agitation were decreased in group DEX + DEZ (P ＜0.05).No side effects such as hypotension,bradycardia,respiratory depression,nausea and vomiting were observed in the four groups.Conclusion Dexmedetomidine or dezocine alone or combination of the two agents can decrease the degree and occurrence of emergence agitation and inhibit the inflammatory response simultaneously,and the combination of the two agents provides better efficacy than either alone in patients undergoing thoracic surgery.