右美托咪定联合纳布啡对腹腔镜胆囊切除术患者全身麻醉苏醒期血流动力学和躁动的影响

Effect of dexmedetomidine combined with nalbuphine on haemodynamics and emergence agitation during recovery from general anesthesia in patients underwent laparoscopic cholecystectomy

摘要:

目的 探讨右美托咪定（DEX）联合纳布啡对腹腔镜胆囊切除术患者全身麻醉苏醒期血流动力学和躁动的影响。方法 选取择期行腹腔镜胆囊切除术的患者120例作为研究对象，采用随机数表法分为4组：对照组（A组）、纳布啡组（B组）、DEX组（C组）和DEX联合纳布啡组（D组），每组各30例。美国麻醉医师协会（ASA）分级为Ⅰ级或Ⅱ级，年龄18～65岁，体重指数（BMI） ≤ 30 kg/m²。于手术结束前10 min，A组静脉注射生理盐水，B组静脉注射纳布啡0.2 mg/kg，C组静脉泵注DEX 0.4 μg/kg，D组静脉注射纳布啡0.2 mg/kg同时泵注DEX 0.4 μg/kg。比较4组患者手术结束时（T₀）、拔除气管导管前（T₁）、拔除气管导管即刻（T₂）、拔除气管导管后5 min（T₃）和拔除气管导管后10 min（T₄）的心率（HR）和平均动脉压（MAP），比较4组患者的苏醒期Ricker镇静-躁动评分（SAS）和呛咳程度。结果 与A组和B组比较，C组和D组苏醒期间血流动力学波动幅度明显减小（P < 0.05）；A组、B组、C组和D组的躁动发生率分别为73.3%、36.7%、46.7%和26.7%，B组和D组躁动率明显低于A组（P < 0.05）；B组、C组和D组的呛咳程度明显轻于A组（P < 0.05）；B组苏醒及拔管时间明显短于A组（P < 0.05）。结论 手术结束前10 min，静脉输注DEX联合纳布啡，可缓解苏醒期血流动力学波动，降低躁动发生率。

Abstract:

Objective To explore the effect of dexmedetomidine (DEX) combined with nalbuphine on haemodynamics and emergence agitation during recovery from general anesthesia in patients underwent laparoscopic cholecystectomy.Methods 120 patients who underwent laparoscopic cholecystectomy, were divided into 4 groups (n = 30 in each group) using a random number table method: control group (group A), nalbuphine group (group B), DEX group (group C), DEX combined with nalbuphine group (group D). American Society of Anesthesiologists (ASA) grade were class I or class II, aged 18 ~ 65 year, with body mass index (BMI) ≤ 30 kg/m². Normal saline, nalbuphine 0.2 mg/kg, DEX 0.4 μg/kg, and nalbuphine 0.2 mg/kg plus DEX 0.4 μg/kg, were injected intravenously in group A, group B, group C and group D respectively at 10 min before the end of operation. Heart rate (HR) and mean arterial pressure (MAP) of all patients were recorded at the following moment: at the end of the operation (T₀), before extubation (T₁), immediately after extubation (T₂), 5 min after extubation (T₃), 10 min after extubation (T₄), the degree of cough during extubation and the Ricker sedation-agitation scale (SAS) were also evaluated.Results Compared with group A and group B, haemodynamics fluctuation was significantly lower in group C and group D (P < 0.05); The corresponding incidence of emergence agitation from 4 groups were: 73.3%, 36.7%, 46.7% and 26.7%. Compared with group A, the incidence of emergence agitation was significantly lower in group B and group D (P < 0.05); Compared with group A, the degree of cough was significantly lower in group B, group C and group D (P < 0.05); Compared with group A, the recovery time and extubation time were significantly shortened in group B (P < 0.05).Conclusion Intravenous infusion of DEX combined with nalbuphine at 10 min before the end of the operation can reduce haemodynamics fluctuation and the incidence of emergence agitation during recovery from general anesthesia in patients undergoing laparoscopic cholecystectomy.