| Objective: Observe the change of haemodynamics and analepsia,as using different density of dexmedetomidine to extubation and analepsia in general anethesia .Light anethesia,pain, stimulus of endotracheal catheter ,air tube clearing and so on,all can produce stress reaction during extubation.It will make people high blood pressure, accelerate heart rate, increase oxygen consumption, myocardial ischemia and airway obstruction happen,also makes hypoxia and chill,even bucking and restlessness.Among all of those, stress reaction of circulation is common,it cause curcular and cerebral accident in patient who are elder ,CHD,or hypertension.we approach the dependablity of haemodynamics and analepsia in extubation.The purpose of this study is to compare the results of using different density of dexmedetomidine to patients in genreal anethesia,includiing haemodynamics and analepsia in extubation.Methods: The patients were chosen to the experiment coincide such qualification ,the one who will accept holocoxa replacement and general anethesia ,ASAIⅡ.They were separated to 4 groups,every conclude 20 people, 2.5μg/ kg dexmedetomidine(group A),1.5μg/ kg dexmedetomidine(group B),0.5μg/ kg dexmedetomidine(group C),0.9%Nac(lgroup D).All patients were inhale drug combine with intravein anethesia ,In anesthesia induction,we use midazolam 0.03mg/kg,propofol 1.2mg / kg,sufentanil 0.4ug / kg,vecuronium 0.1mg / kg intravenous. Providing oxygen and denitrogenation 3 minutes,then we do endotracheal tube,after that we connect anaeshetic machine with IPPV,using mechanical control breath,VTas( 8- 10) m l/kg , RR12per minute, I:E as 1:2.During the operation,we never boost drugs intravenous,breath in N2O:O2 (1:1) and 1% - 3% sevoflurane,keeping MAC as1.3-1.4,to make vital sign steady.Druging at 30 minutes before operation finishment,TCI all the drugs ,finished in 10 minutes ,group A invenous pumping 2.5μg/ kg dexmedetomidine , group B invenous pumping 1.5μg/ kg dexmedetomidine,group C invenouspumping 0.5μg/ kg dexmedetomidine, group D invenous pumping 0.9% Nacl. Observe and record systolic blood pressure ( SBP),diastolic blood pressure ( DBP),heart rate (HR) ,myocardial consumption of oxygen(MCO),at the following time ,such as before medication(T0),before extubation (T1),at extubation (T2),after extubation 3min( T3),and record analepsia time ( t1 ),extubating time ( t2 ),Ta (30min after operation),Tb(35min after operation), Tc(40min after operation)OAA/S scores.All data were given by mean±standard deviation. Used SPSS 13.0 statistical software for statistical processing to deal with data. In the group, used paired t test to compare the data and we used the t test to compare between the two groups. P <0.05 for the the difference was significant.Results: Compare in group ,T1 compare with T0, there is satistics difference among the groupA,B,Cwith SBP,DBP,HR and MCO(P<0.05),D group is no satistics difference(P>0.05). T2 compare with T1,There is no marked change of SBP ,DBP, HR and MCO in group A and B(P>0.05), D group has change (P<0.05). T3 compare with T2, There is no marked change of SBP ,DBP, HR and MCO in group A and B(P>0.05),but C and D has changed ( P<0.05 ) .Compared among groups,at the time of T1,observe SBP ,DBP,HR,MCO,groupA,group B and C has no marked change(P>0.05), but D is different from every group(P<0.05).At the time of T2 and T 3, there is no marked change of SBP ,DBP, HR and MCO in group A and B(P>0.05),but C and D compared with A and B has changed(P<0.05),between C and D ,SBP and DBP has no change(P>0.05),but HR and MCO has marked change (P<0.05).Comparing among groups, t1 and t2,there is no difference among the last three groups ( P>0.05 ) ,but A is different from everyone(P<0.05).Compare in group, Tb compare with Ta,Tc compare with Tb,the four groups all markedly grow(P<0.05).Compare among group, Ta,Tb andT c,the OAA/S has no difference in A,B and C(P>0.05),but A is different from everyone (P<0.05).Conclusion: 1.5μg/ kg Dexmedetomidine can obviously depress cardiovascular effects around extubation in general anethesia ,reinfore the patients'tolerance to tracheal catheter,shorten the time of analepsia and extubation.The influenc maybe connect with affection onα2 adrenergic receptor in central and periphery neuron, to inhibit adrenergic nerve and analgesic effect. |
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