文章摘要
极低剂量右美托咪定对老年患者全身麻醉苏醒期呛咳的影响
Effect of ultra-low dose dexmedetomidine on cough during anesthesia recovery period in elderly patients
  
DOI：10.12089/jca.2024.02.002
中文关键词: 右美托咪定  麻醉苏醒期  呛咳  颈动脉支架置入术  老年
英文关键词: Dexmedetomidine  Anesthesia recovery period  Cough  Carotid artery stenting  Aged
基金项目:国家重点研发项目（2018YFC2001805）
作者单位E-mail
王晓宁 100038,首都医科大学附属北京世纪坛医院麻醉科  
张丽红 中国医科大学附属盛京医院麻醉科  
李天佐 100038,首都医科大学附属北京世纪坛医院麻醉科 ltzmzksss@126.com 
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中文摘要:
      
目的：探讨极低剂量右美托咪定对老年患者颈动脉支架置入术（CAS）全身麻醉苏醒期呛咳的影响。
方法：选择择期行CAS的无症状单侧重度颈动脉狭窄老年患者111例，男75例，女36例，年龄≥65岁，BMI 18～32 kg/m2，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：右美托咪定组（D组，n=55）和对照组（C组，n=56）。D组于麻醉诱导前给予右美托咪定0.2～0.5 μg/kg，麻醉诱导后至手术结束前30 min静脉输注极低剂量右美托咪定0.1～0.2 μg·kg-1·h-1；C组不给予右美托咪定。两组麻醉方案及术中用药方案相同。记录麻醉诱导前15 min（T0）、麻醉诱导后5 min（T1）、支架置入前5 min（T2）、支架置入后5 min（T3）、气管拔管后5 min（T4）的MAP和HR。记录术中丙泊酚和瑞芬太尼用量、麻醉苏醒期呛咳、躁动、呼吸抑制（SpO2<90%）、拔管时间以及术后穿刺处感染、术后24 h VAS疼痛评分、术后恶心呕吐的发生情况。
结果：与C组比较，D组T1、T2时MAP明显升高，T3、T4时MAP明显降低，T1、T3、T4时HR明显减慢（P<0.05），术中丙泊酚和瑞芬太尼用量明显减少（P<0.05），麻醉苏醒期呛咳、躁动发生率明显降低（P<0.05）。两组呼吸抑制发生率、拔管时间、术后24 h VAS疼痛评分以及术后恶心呕吐发生率差异无统计学意义，两组均未发生术后穿刺处感染。
结论：极低剂量右美托咪定可有效维持术中血流动力学稳定性，降低麻醉苏醒期呛咳、躁动发生率，且不增加术后不良反应，提高全身麻醉苏醒质量。
英文摘要:
      
Objective: To explore the effect of ultra-low dose dexmedetomidine on cough during anesthesia recovery period in elderly patients undergoing carotid artery stenting (CAS).
Methods: A total of 111 elderly patients, 75 males and 36 females, aged ≥ 65 years, BMI 18-32 kg/m2, ASA physical status Ⅱ or Ⅲ, diagnosed with asymptomatic unilateral severe carotid artery stenosis and scheduled for CAS, were randomly assigned to two groups using a random number table: the dexmedetomidine group (group D, n = 55) and the control group (group C, n = 56). Group D was given dexmedetomidine 0.2-0.5 μg/kg before anesthesia induction, and dexmedetomidine was intravenously infused at a ultra-low dose (0.1-0.2 μg·kg-1·h-1) after anesthesia induction to 30 minutes before the end of the operation, while group C did not receive any dexmedetomidine. The anesthesia regimen and intraoperative medication were the same for both groups. The MAP and HR were recorded 15 minutes before anesthesia induction (T0), 5 minutes after anesthesia induction (T1), 5 minutes before stent implantation (T2), 5 minutes after stent implantation (T3), and 5 minutes after tracheal extubation (T4). The dosage of intraoperative propofol and remifentanil, cough and agitation during anesthesia recovery period, respiratory depression (SpO2< 90%), extubation time, postoperative puncture infection, VAS pain score 24 hours after surgery, and postoperative nausea and vomiting were recorded.
Results: Compared with group C, MAP was significantly decreased at T1 and T2, increased at T3 and T4, and HR was significantly decreased at T1, T3, and T4 in group D (P < 0.05). Compared with group C, the intraoperative use of propofol and remifentanil was significantly decreased, and the incidence of cough and agitation during anesthesia recovery period was significantly decreased in group D (P < 0.05). There was no statistically significant difference in the incidence of respiratory depression, extubation time, VAS pain score 24 hours after surgery, and postoperative nausea and vomiting between the two groups. None of the recruited patients experienced infection at the puncture site.
Conclusion: Ultra-low dose dexmedetomidine can effectively maintain intraoperative hemodynamic stability, reduce the incidence of cough and agitation during anesthesia recovery period, and does not increase other postoperative adverse reactions,enhancing anesthesia recovery quality in elderly patients undergoing CAS.
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