摘要目的 评价右美托咪定对后路截骨矫形术患者术中唤醒试验质量的影响.方法 择期全麻下行后路截骨矫形术的中重度胸腰椎后凸畸形患者97例,年龄17～59岁,性别不限,ASA分级Ⅰ或Ⅱ级,体重指数18.5 ～ 25.0 kg/m2,最大后凸角＞60°.采用随机数字表法,将其分为2组:对照组(C组,n=46)和右美托咪定组(D组,n=51).D组于麻醉诱导前经15 min静脉输注右美托咪定1.0 μg/kg,C组静脉输注等容量生理盐水.静脉注射咪达唑仑、异丙酚、芬太尼、维库溴铵和地塞米松诱导麻醉,气管插管后行机械通气.静脉输注顺式阿曲库铵、异丙酚和瑞芬太尼维持麻醉,D组静脉输注右美托咪定0.3 μg·kg-1·h-1至术毕,C组静脉输注等容量生理盐水至术毕.唤醒试验前C组停止输注麻醉维持药物;D组停止输注顺式阿曲库铵、异丙酚和瑞芬太尼,右美托咪定的输注速率不变.记录唤醒时间,评价唤醒质量,记录唤醒成功时Ramsay镇静评分和Riker躁动评分,记录唤醒期间心血管事件的发生情况.记录术中知晓和术后恶心呕吐、寒战的发生情况.结果 结果与C组比较,D组唤醒质量升高,唤醒成功时Ramsay镇静评分升高,Riker躁动评分降低,术后恶心呕吐发生率降低(P＜0.05),唤醒时间差异无统计学意义(P＞0.05).2组未发生心血管事件和术中知晓.结论 右美托咪定可提高后路截骨矫形术患者术中唤醒试验唤醒的质量,不延长唤醒时间,血流动力学稳定,不良反应少.

abstractsObjective To evaluate the effect of dexmedetomidine on quality of wake-up test in the patients undergoing posterior osteotomy correction surgery.Methods Ninety-seven patients of both sexes,aged 17-59 yr,of ASA physical status Ⅰ or Ⅱ,with body mass index 18.5-25.0 kg/m2 and global kyphosis angle＞60°,scheduled for elective posterior osteotomy correction surgery under general anesthesia,were randomly divided into 2 groups using a random number table:control group C (n=46) and group D (n =51).In group D,dexmedetomidine 1.0 μg/kg was infused over 15 min before induction of anesthesia,and group C received the equal volume of normal saline instead.Anesthesia was induced with iv midazolam,propofol,fentanyl,vecuronium and dexamethasone in C and D groups.Mechanical ventilation was performed after tracheal intubation.Anesthesia was maintained with infusion of cisstracurium,propofol and remifentanil.Dexmedetomidine 0.3 μg · kg-1 · h-1 was infused throughout the surgery in group D,and meanwhile normal saline was given throughout the surgery in group C.The anesthetic drugs for maintenance except dexmedetomidine were discontinued at the beginning of the wake-up test.The wake-up time was recorded and the wake-up quality was assessed.Ramsay sedation scores and Riker sedation-agitation scale scores were also recorded when all the patients were successfully awakened.The development of cardiovascular events during wake-up test and intraoperative awareness was recorded.Results The wake-up quality was significantly higher,Riker sedation-agitation scale scores were lower,Ramsay sedation scores were higher,the incidence of nausea and vomiting was lower,and no significant change was found in wake-up time in group D.No intraoperative awareness was observed in the two groups.Conclusion Dexmedetomidine can raise wake-up quality without prolonging wake-up time and with stable hemodynamics and fewer side effects in the patients undergoing posterior osteotomy correction surgery.