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目的比较右美托咪定与多沙普仑预防全身麻醉下食管癌根治术后寒战反应的效果。方法择期全身麻醉下行食管癌根治术患者90例,随机分为右美托咪定组、多沙普伦组和对照组各30例。右美托咪定组气管插管后静脉泵注负荷剂量右美托咪定0.8μg/kg,10min泵注完后以0.4μg/(kg·h)维持至关胸前;多沙普伦组术毕即刻静脉注射多沙普伦1mg/kg;对照组术毕即刻静脉注射生理盐水5mL。比较3组寒战发生率、寒战出现时间及寒战持续时间,记录入麻醉恢复室即刻(T1)、10min(T2)、30min(T3)时Ramsay镇静评分(ramsay sedation score,RSS)和视觉模拟评分(visual analogue scale,VAS)。结果右美托咪定组寒战发生率、寒战出现时间及寒战持续时间分别为10.0%、(17.3±14.4)min、(10.5±5.1)min,多沙普伦组分别为6.7%、(16.3±12.1)min、(11.3±6.7)min,对照组分别为43.3%、(15.1±10.3)min、(11.8±8.8)min,对照组寒战发生率高于右美托咪定组和多沙普伦组(P<0.05),右美托咪定组寒战发生率与多沙普伦组比较差异无统计学意义(P>0.05);3组寒战出现时间、寒战持续时间比较差异无统计学意义(P>0.05);T1、T2、T3时间点右美托咪定组VAS评分(1.1±0.4、2.0±0.6、2.1±0.5)低于多沙普伦组(3.9±0.6、4.1±0.3、3.8±0.6)和对照组(4.2±0.8、4.3±0.6、4.0±0.6)(P均<0.05);T1、T2时间点右美托咪定组RSS评分(3.2±0.6、2.8±0.4)高于多沙普伦组(1.9±0.3、1.7±0.6)和对照组(2.0±0.2、1.7±0.5)(P均<0.05)。结论食管癌根治术中应用右美托咪定、多沙普仑均可有效预防术后寒战的发生,但应用右美托咪定可减轻患者术后疼痛,增加镇静效果。
Objective To compare the effect of dexmedetomidine and doxapram on prevention of chills after esophagectomy under general anesthesia. Methods Ninety patients undergoing esophagectomy undergoing elective general anesthesia were randomly divided into three groups: dexmedetomidine group, docetaxel group and control group. The right dexmedetomidine group after intravenous intubation intravenous injection of dexmedetomidine dose of 0.8μg / kg, 10min after the injection of the pump to 0.4μg / (kg · h) remained closed to the chest; doxapram group Immediate intravenous infusion of doxapram 1mg / kg; control group received intravenous injection of normal saline 5mL. The incidences of chills, chills and chills duration were compared between the three groups. Ramsay sedation score (Ramsay) and visual analogue scale (RTS) scores were recorded immediately after anesthesia recovery room (T1), 10 min (T2), 30 min visual analogue scale, VAS). Results The incidence of chills, chills and chills duration in dexmedetomidine group were 10.0% (17.3 ± 14.4) min and 10.5 ± 5.1 min, respectively, with doxapram being 6.7% and 16.3 ± 12.1) min and (11.3 ± 6.7) min in control group were 43.3%, (15.1 ± 10.3) min and (11.8 ± 8.8) min, respectively. The incidence of cholera in control group was higher than that in dexmedetomidine group and doxapram (P <0.05). There was no significant difference in the incidence of cholera between the dexmedetomidine group and the docetaxel group (P> 0.05). There was no significant difference in cholera occurrence time and chills duration between the three groups (P> 0.05). The VAS score of dexmedetomidine group at T1, T2 and T3 was lower than that of doxapram group (1.1 ± 0.4, 2.0 ± 0.6, 2.1 ± 0.5) ± 0.6) and control group (4.2 ± 0.8, 4.3 ± 0.6, 4.0 ± 0.6) respectively (all P <0.05). At the time points of T1 and T2, the RSS score of the dexmedetomidine group was (3.2 ± 0.6,2.8 ± 0.4) The doxapram group (1.9 ± 0.3, 1.7 ± 0.6) and the control group (2.0 ± 0.2, 1.7 ± 0.5) (all P <0.05). Conclusion The application of dexmedetomidine and doxapram in the radical operation of esophageal cancer can effectively prevent the occurrence of postoperative chills, but the application of dexmedetomidine can reduce postoperative pain and increase the sedation effect.