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目的 探讨右美托咪定对甲状腺手术患者呛咳反应的影响.方法 择期全麻下甲状腺肿瘤手术患者118例,男43例,女75例,年龄18~65岁,BMI 18~30 kg/m2,ASA Ⅰ或Ⅱ级,采用随机数字表法分为两组,每组59例.D组在手术开始时持续静脉泵注右美托咪定0.4 μg·kg-1·h-1至手术结束,C组在手术开始时持续静脉泵注等容量生理盐水至手术结束.观察患者全麻恢复期间呛咳发生情况,记录患者术后24、48 h引流量,以及心动过速、低血压、高血压、心动过缓等不良反应的发生情况.结果 D组全麻恢复期间呛咳发生率明显低于C组(10.1% vs 30.5%,P<0.05),D组术后第1个24 h[(62.3±26.8)ml vs (78.6±30.1)ml,P<0.05]、第2个24 h[(28.0±12.5)ml vs (37.5±18.6)ml,P<0.05]引流量明显少于C组;D组围术期心动过速发生率明显低于C组(3.4% vs 23.7%,P<0.05).结论 术中持续输注右美托咪定0.4 μg·kg-1·h-1能够有效减轻甲状腺手术患者全麻恢复期间的呛咳反应,降低患者术后出血的风险.“,”Objective To evaluate the effect of dexmedetomidine on postoperative cough and the postoperative bleeding in patients undergoing thyroid surgery.Methods A total of 118 aged 18-65 years,BMI 18-30 kg/m2,ASA physical status Ⅰ or Ⅱ patients,scheduled for elective thyroid surgery,were randomly divided into 2 groups (n=59 each): dexmedetomidine group (group D) and control group (group C).At the beginning of the operation,patients in group D were infused with dexmedetomidine at a rate of 0.4 μg·kg-1·h-1until the end of surgery.Meanwhile,the equal volume of normal saline was infused in group C.The incidence and severity of coughing during recovery,the volume of drainage at first and second 24 h after surgery,the occurrence of adverse events were recorded.Results Compared with group C,the incidence of coughing were lower in group D (10.1% vs 30.5%,P<0.05).The volume of drainage at first 24 h [(62.3±26.8) ml vs (78.6±30.1) ml,P<0.05] and second 24 h after surgery were less in group D than those in group C.Compared with group C,the dosage of propofol and remifentanil were lower in group D (P<0.05).Compared with group C,the incidence of tachycardia during recovery decreased in group D (3.4% vs 23.7%,P<0.05).Conclusion Continuous infusion of dexmedetomidine at a rate of 0.4 μg·kg-1·h-1 in patients undergoing thyroid surgery with general anesthesia can relieve cough reflex,reduce the risk of the postoperative bleeding.