【摘要】 目的 探讨术前焦虑患者术中应用右美托咪定的镇静效果。方法 选取2015年3—5月于汕头大学医学院第一附属医院行下腹部或下肢手术患者80例,术前1 d采用阿姆斯特丹术前焦虑量表（APAIS）评估患者术前焦虑程度。根据有无术前焦虑分为术前焦虑组（44例）和无术前焦虑组（36例）。所有患者椎管内麻醉完成后,静脉泵注右美托咪定负荷剂量1μg/k（10 min）后以0.5μg/（kg·h）维持剂量输注至手术结束前40 min。记录并比较患者Ramsay镇静评分达4分时所需时间,入室时（T₁）、给予右美托咪定即刻（T₂）、5 min（T₃）、10 min（T4）及15 min（T₅）各时点的血压、平均动脉压、心率、脉搏血氧饱和度（SpO₂）。结果 患者Ramsay镇静评分达4分时所需时间与APAIS评分符合线性相关（r²=0.333,P<0.01）,且无术前焦虑组患者所需时间明显短于术前焦虑组[（9.0±1.7）min比（11.7±2.5）min],差异有统计学意义（P<0.01）。术前焦虑组44例患者中有14例（31.8%）在以0.5μg/（kg·h）维持时镇静效果不佳,易发生睁眼、体动,需要调高维持剂量才能继续维持满意的镇静。T2时点,2组收缩压、舒张压、平均动脉压均低于T₁时点[术前焦虑组:（120±15）mmHg（1 mmHg=0.133 kPa）比（126±14）mmHg,（71±10）mmHg比（77±10）mmHg,（84±11）mmHg比（91±11）mmHg;无术前焦虑组:（118±10）mmHg比（122±15）mmHg,（69±14）mmHg比（73±13）mmHg,（83±10）mmHg比（87±12）mmHg],心率均高于T₁和T₃时点[（88±17）次/min比（81±15）、（72±15）次/min;（78±12）次/min比（75±1 1）、（64±10）次/min],且T₁^T₅时点,术前焦虑组患者心率均明显高于无术前焦虑组[T₄时点:（67±12）次/min比（62±8）次/min;T₅时点:（68±12）次/min比（64±8）次/min],差异均有统计学意义（均P<0.05）。2组各时点SpO₂比较,差异均无统计学意义（均P>0.05）。80例患者中,25例（31.3%）于泵注负荷剂量时出现心率减慢,仅3例（3.8%）出现低血压。结论 术前焦虑程度与术中获得满意镇静所需时间相关,对于存在术前焦虑的患者使用右美托咪定术中镇静时应酌情增加剂量。更多还原

【Abstract】 Objective To observe the sedative effects of intraoperative application of dexmedetomidine（DEX） in patients with preoperative anxiety.Methods Eighty patients who underwent lower abdominal or lower extremity operation from March to May 2015 were enrolled.The preoperative anxiety level were evaluated by Amsterdam preoperative anxiety and information scale（APAIS）.The patients were divided into anxiety group（44 cases） and non-αnxiety group（36 cases） according to the APAIS result.After induction of intrathecal anesthesia,all the patients received bolus injection of load dose of DEX（10 μg/kg）,followed by intravenous infusion of maintain dose[0.5 μg/（kg · h）]till to 40 min before end of the operation.The time needed for reaching Ramsay sedation score 4 was recorded.The blood pressure,mean arterial pressure,heart rate,blood pressure,oxygen saturation（SpO₂） on admission to the operating room（T₁）,immediately（T₂）,5 min（T₃）,10 min（T₄） and 15 min（T₅） after administration of DEX were recorded.Results The time needed for reaching Ramsay sedation score 4 was significantly correlated with APAIS score（r² = 0.333,P < 0.01）:the time in non-αnxiety group was significantly shorter than that in anxiety group[（9.0 ± 1.7） min vs（11.7 ± 2.5） min]（P <0.01）.Forteen patients（31.8%） in anxiety group had unsatisfied sedation and were more prone to move and open eyes during operation,requiring to increase the maintained dose for satisfied sedation.At T₂ point,the systolic blood pressure,diastolic blood pressure and mean arterial pressure were significantly lower than those at T₁ point in anxiety group[（120 ±15） mmHg vs（126 ± 14） mmHg,（71 ± 10） mmHg vs（77 ± 10） mmHg,（84 ±11） mmHg vs（91 ±11） mmHg]and non-αnxiety group[（118 ± 10） mmHg vs（122 ± 15） mmHg,（69 ±14） mmHg vs（73 ± 13） mmHg,（83 ± 10） mmHg vs（87 ± 12） mmHg]（P<0.05）:the heart rate at T₂ point was significantly higher than that at T₁ and T₃ point in anxiety group[（88 ± 17） times/min vs（81 ± 15）,（72 ±15） times/min]and non-αnxiety group[（78 ±12） times/min vs（75 ± 11）,（64 ± 10） times/min]（P <0.05）:the heart rate in anxiety group was significantly higher than that in non-αnxiety group at T₁-T₄ point[（67 ±12） times/min vs（62±8） times/min:（68±12） times/min vs（64±8） times/min]（P<0.05）.No differences regarding SpO₂ at all the time points were found between the two groups（P > 0.05）.Decreased heart rate occurred in 25 patients（31.3%） during bolus injection,hypotension occurred in 3 patients.Conclusion The preoperative anxiety is con-elated with the time required for reaching satisfied sedation:the dose of intraoperative DEX should be increased according to the preoperative anxiety degree for obtaining satisfied sedation.更多还原