| For a long time, when tidal volume returned to normal and patients waked fully , patients in anesthesia can extube the tracheal. The hemodynamic response in these patients is more sever: when a serious adverse reactions such as extubation of restlessness, the secretion of catecholamines in the blood increased, the cardiovascular response to stress occurs, clinical manifestations of heart rate, blood pressure, shortness of breath, increased myocardial oxygen consumption, and may make the patient some degree of mental disorder. Ideal tracheal extubation period including the stability of circulatory system and respiratory system, the patient regained consciousness quickly and without serious side effects during tracheal extubation period and severe adverse drug reactions. Currently, the maintenance of tracheal extubation period hemodynamic stability, reduce the incidence of adverse reactions, clinical workers have paid the majority of attention.ObjectiveThe aim of the experiement is observing the effect of dexmedetomidine hydrochloride's to the heart rate , respiratory rate , systolic blood pressure , driastolic blood pressure and side effects in extubation period in patients of general anesthesia extubation period , which evaluate the effects of dexmedetomidine to hemodynamic in general anesthesia and provided the guidance for clinical practice.Subjects and MethodsChoose 50 cases Journal of the American Medical Association in October 2009 to March 2010 undergoing elective surgery in general anesthesia, the American Medical Association (ASA) grade II ~ III, aged 18 to 80 years old, weighing 50 to 80kg, NYHA class is I ~ II grade. No previous history of myocardial infarction and cerebral vascular accident. There is no significant myocardial ischemia change preoperative and intraoperative. Patients with liver dysfunction is out. There is tracheal intubation difficulty (with a primary physician qualified anesthesiologist failed intubation attempt twice ) and other obesity is out. Except the patients who allergy of study drug. Except pregnant or lactating women. Long-term use sedatives, are mentally ill or for other reasons other than the end of surgery can not be partners. The patients who imply intraoperative hypotension or normovolemic hemodilution is excepted. Intraoperative unforeseen circumstances, such as massive blood loss, blood loss>15ml/kg, etc.) is out. Operative time was more than 4 hours otherwise. The patients in nearly half of the year who except other clinical investigators in other drugs is out.50 patients were randomly selected to take single-blind method, by drawing of lots divided into A, B group, n = 25. Subjects after the burglary, open venous access, connectivity monitoring, ECG, blood pressure (SBP, DBP) and SpO2. Group A is the experimental group, the patients were given dexmedetomidine hydrochlorid 0.5μg ? kg-1 ? h-1 before 30 minutes of the end of the surgery. Group B is control group, the patients were given the same volume of 0.9% sodium chloride injection continuous infusion. Follow-up observation of the project and measures:①the general condition of the patient;②Vital signs, including blood pressure (BP), heart rate (HR), pulse oxygen saturation (SpO2), respiratory rate (RR);③the changes of hemodynamic between before extubation and after extubation,including blood pressure (BP), heart rate (HR), pulse oxygen saturation (SpO2), respiratory rate (RR);④Adverse reactions during extubation period.Result⑴There is no significant difference in age, weight, operation time, anesthesia time and the volume of intraoperative transfusion of both of groups.⑵There is no significant difference of SBP, DBP and HR between two groups before induction of general anesthesiology.⑶Contract two groups of extubation SBP, DBP and HR, the control group (group B) hemodynamic changes greatly between pre-extubation and after extubation while the experimental group (group A) changes is no significant, there is significant difference in control group between pre-extubation period and after extubation period.⑷Adverse reactions of two groups during tracheal extubation period, the experimental group of agitation and pain was less than the control group, there is significant difference between two group, there is no significant difference in respiratory depression, nausea, vomiting, shivering of both groups . In this experiment, the main reason for application of the dexmedetomidine in tracheal extubation period is:①Dexmedetomidine given the role of moderate sedation which can make patients more comfortable during extubation period;②Dexmeditomidine can reduce the hemodynamic response during extubation period, and in theory, it does not affect recover time and recover quality of patients.③the side effects of dexmedetomidine is lower, the rates of respiratory depression is lower, so it is relatively safe in application of dexmedetomidine. It is difficult for some patients with atrioventricular block.④Although dexmedetomidine given alone without significant analgesic effect, but when combined with analgesics, it may enhance its analgesic effects, prolonged analgesia time, pain causes patients to avoid postoperative agitation.⑤Another advantage of dexmedetomidine is that it can be effectively inhibit postoperative shivering, restlessness, nausea, vomiting, but the specific mechanism is currently unknown. Dexmedetomidine is a good anesthetic adjuvant drug, it can make hemodynamic stability in extubation station. From the results of this experiment, dexmedetomidine determined not only extend the anesthesia recovery time, reduce the circulatory system and respiratory system response, the experimental group patients were less postoperative agitation, reduce the circumference pull management of the discomfort.Conclusion1,In general anesthesia tracheal extubation period, dexmedetomidine is good for cardiovascular stablility. It did not prolong the recover time and effectively reducing the early resumption of the hemodynamic response.2,In general anesthesia tracheal extubation period, dexmedetomidine can reduce the pain of tracheal extubation period, low incidence of pain. And compare with the saline group, there is not significant chills, nausea, vomiting, respiratory depression occurring. |
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