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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 0.5 滋g/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0.5 滋g/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。

英文摘要:

Objective: To observe the effect of single-dose dexmedetomindine on trachea incision under local anesthesia in laryngocarcinoma.Methods: Forty laryngocarcinoma patients who would treated with selective tracheotomy and trachea incision were randomly divided into 2 groups (n=16): dexmedetomindine (Dex) group (group D) and control group (group C). 0.5 滋g/kg dexmedetomindine was infused intravenously 15 min before local anesthesia in groupD (within 10 min), while equal volume of normal saline was infused in group C. Local anesthesia undergoing incision of trachea was performed 5 min later mean arterial pressure (MAP), heart rate (HR), pulse oxygen saturation (SpO2) and respiration rate (RR) were monitored and recorded at the time points of pre-administration (T0), beginning of local anesthesia (T1), during skin incision (T2), during endotracheal anesthesia (T3), during incision of trachea stoma (T4). VAS score, Ramsay score and operating tolerance degree score were also calculated and compared. Results: Compared with T0, the values of MAP, HR at T1-T4 in group C significantly increased (P<0.05), MAP of patients in group C rose obviously at the moment of T3-T4 (P<0.05). MAP and HR at T1-T4 in group D were significantly decreased (P<0.05) . Compared with group C, MAP and HR in group D at T1-T4 were all significantly lower, (P<0.05) but no significant difference of SpO2 and RR was found (P>0.05), VAS score decreased, while Ramsay score and operating tolerance degree score increased significantly (P<0.05).Conclusion: A single dose 0.5 滋g/kg of dexmedetomindine given intravenously before local anesthesia could effectively maintain the hemodynamic stability and significantly presents obvious sedation and analgesic effects.

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