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目的:探讨预注右美托嘧啶(dexmedetomindine,Dex)对喉癌患者局麻下行气管切开时的影响。方法:选择择期喉癌手术拟行气管切开的患者40例,随机分为Dex组(D组)和生理盐水组(C组),D组在局麻前静脉注射Dex 0.5μg/kg(10 min泵注完毕),C组以相同方式泵注等量生理盐水,观察5 min后开始行局麻下气管切开。分别记录两组患者给药前(T0)、局麻开始时(T1)、切皮时(T2)、气管内麻醉时(T3)、气管切开造口时(T4)的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)和呼吸次数(RR);观察并记录患者T1~T4各时间点的VAS评分、Ramsay镇静评分和手术耐受程度评分。结果:与T0相比,C组T1~T4各时点MAP和HR均升高,尤以T3~T4时明显(P<0.05),D组T1-4时MAP下降、HR明显减慢(P<0.05);与C组相比,D组T1~T4各时间点MAP均显著下降(P<0.05),HR均明显减慢(P<0.01),VAS评分显著降低(P<0.05),手术耐受程度评分和Ramsay镇静评分均显著升高(P<0.05)。结论:喉癌患者行局麻气管切开前预先静注右美托嘧啶0.5μg/kg(10min泵注完毕),可有效维持血液动力学稳定,并产生明显的镇静、镇痛作用。
Objective: To investigate the effect of pre-injection of dexmedetomindine (Dex) on tracheotomy under local anesthesia in patients with laryngeal cancer. Methods: Forty patients with tracheotomy scheduled for laryngeal cancer undergoing elective surgery were randomly divided into Dex group (group D) and saline group (group C). In group D, Dex 0.5 μg / kg min pump is completed), C group in the same way by pumping the same amount of saline, 5 min after the start of tracheotomy under local anesthesia. The mean arterial pressure (MAP) of the two groups before treatment (T0), at the start of local anesthesia (T1), incision (T2), endotracheal anesthesia (T3) and tracheostomy (T4) HR, SpO2 and RR were recorded. VAS score, Ramsay sedation score and surgical tolerance score of patients at T1 ~ T4 were observed and recorded. Results: Compared with T0, MAP and HR in group C were significantly increased at T1 ~ T4, especially at T3 ~ T4 (P <0.05) <0.05). Compared with group C, the MAP in group D decreased significantly at all time points (P <0.05), the HR decreased significantly (P <0.01), the VAS score decreased significantly (P <0.05) Tolerability score and Ramsay sedation score were significantly increased (P <0.05). Conclusions: Dexmedetomidine (0.5 μg / kg) is injected intravenously before tracheal intubation in patients with laryngocarcinoma, which can effectively maintain the hemodynamic stability and produce obvious sedative and analgesic effects.