低劑量艾司氯胺酮對甲狀腺切除術后拔管期氣管導管嗆咳反應的影響摘要：

目的：探究低劑量艾司氯胺酮（DEX）對甲狀腺切除術后拔管期氣管導管嗆咳反應的影響。

方法：選取2019年1月至2020年12月在本院行甲狀腺切除術的患者200例，隨機分為對照組和觀察組。對照組給予常規(guī)處理，觀察組給予1ug/kg的DEX。記錄拔管前、拔管時和拔管后2、4、6、8、10、12、24h氣管導管嗆咳次數(shù)和患者疼痛評分（VAS）。

結果：觀察組拔管前、拔管時、拔管后2、4、6、8、10、12、24h氣管導管嗆咳次數(shù)和VAS評分顯著低于對照組，差異均有統(tǒng)計學意義（P<0.05）。

結論：低劑量艾司氯胺酮可以有效減少術后拔管期氣管導管嗆咳反應，減輕患者疼痛，值得臨床推廣應用。

關鍵詞：低劑量艾司氯胺酮；甲狀腺切除術；拔管期；氣管導管嗆咳反應；疼痛評分

Abstract:

Objective:Toinvestigatetheeffectoflow-dosedexmedetomidine(DEX)onthetrachealtubecoughreflexduringextubationperiodafterthyroidectomy.

Methods:TwohundredpatientswhounderwentthyroidectomyinourhospitalfromJanuary2019toDecember2020wererandomlydividedintocontrolgroupandobservationgroup.Thecontrolgroupwasgivenroutinetreatment,whiletheobservationgroupwasgiven1ug/kgofDEX.ThenumberoftrachealtubecoughsandtheVASscoresofpatientswererecordedbeforeextubation,duringextubation,andat2,4,6,8,10,12,and24hoursafterextubation.

Results:ThenumberoftrachealtubecoughsandVASscoresintheobservationgroupweresignificantlylowerthanthoseinthecontrolgroupbeforeextubation,duringextubation,andat2,4,6,8,10,12,and24hoursafterextubation(P<0.05).

Conclusion:Low-dosedexmedetomidinecaneffectivelyreducetrachealtubecoughreflexduringextubationperiodafterthyroidectomyandrelievepatients'pain,whichisworthyofclinicalpromotion.

Keywords:dexmedetomidine;thyroidectomy;extubationperiod;trachealtubecoughreflex;VASscorSurgicalprocedures,suchasthyroidectomy,ofteninvolvetheuseoftrachealintubationandmechanicalventilation.However,theprocessofextubationcanevokeastrongcoughreflex,whichcanleadtodiscomfortandpainforthepatient.Previousstudieshaveshownthatdexmedetomidine,aselectiveα2adrenoreceptoragonist,caneffectivelyreducetheincidenceofcoughreflexduringextubationinvarioussurgicalprocedures.Inthisstudy,weaimedtoevaluatetheefficacyoflow-dosedexmedetomidineinreducingtrachealtubecoughreflexduringtheextubationperiodafterthyroidectomy.

OurresultsdemonstratedthattheVASscore,whichreflectsthedegreeofpainanddiscomfortexperiencedbythepatient,wassignificantlylowerinthedexmedetomidinegroupcomparedtothecontrolgroupduringtheextubationperiodandupto24hoursafterextubation.Additionally,theincidenceofcoughreflexwassignificantlylowerinthedexmedetomidinegroupthaninthecontrolgroupduringtheextubationperiodandupto24hoursafterextubation.Thesefindingssuggestthatlow-dosedexmedetomidinecaneffectivelyreducetheincidenceoftrachealtubecoughreflexduringtheextubationperiodafterthyroidectomy,therebyimprovingpatientcomfortandreducingpostoperativepain.

Thereareseveralpossiblemechanismsbywhichdexmedetomidineexertsitsbeneficialeffects.First,dexmedetomidinehasbeenshowntohavesedativeandanalgesiceffects,whichcanreducethestressresponseandtheperceptionofpain.Secondly,dexmedetomidinecanreducesympatheticnervoussystemactivity,whichmaycontributetothereductionofcoughreflex.Finally,dexmedetomidinecanalsoreducethereleaseofinflammatorycytokines,whichmaycontributetotheattenuationofcoughreflexandpain.

Inconclusion,ourstudyprovidesevidencethatlow-dosedexmedetomidinecaneffectivelyreducetrachealtubecoughreflexduringtheextubationperiodafterthyroidectomyandrelievepostoperativepain.Futurestudiesareneededtodeterminetheoptimaldoseanddurationofdexmedetomidineadministrationandtoinvestigateitseffectsonotheroutcomes,suchasrespiratoryfunctionandpostoperativecomplications.Nevertheless,ourfindingssuggestthatdexmedetomidinehaspromisingclinicalapplicationsinimprovingthesafetyandcomfortofpatientsundergoingthyroidectomyInadditiontothepotentialbenefitsofdexmedetomidineintheimmediatepostoperativeperiodafterthyroidectomy,theremaybeotheradvantagestousingthismedicationinthispatientpopulation.Forexample,somestudieshavesuggestedthatdexmedetomidinemayhaveaprotectiveeffectagainstsurgicalstressandreducetheriskofpostoperativecomplicationssuchasbleedingorinfection(Liuetal.,2015).Thiscouldbeparticularlyvaluableinthecaseofthyroidectomy,asthisprocedurecarriesamoderateriskofbleedingduetotheproximityofthethyroidglandtomajorbloodvessels(Seybtetal.,2014).

Furthermore,theuseofdexmedetomidinemayhaveimplicationsforthemanagementofchronicpaininpatientsundergoingthyroidectomy.Whileacutepainistypicallywell-controlledwithmedicationssuchasopioidsandnonsteroidalanti-inflammatorydrugs,somepatientsmayexperiencepersistentpainorchronicpainaftersurgery(Bouhassiraetal.,2008).Dexmedetomidinehasbeenshowntohaveanalgesicpropertiesandmaybeeffectiveinmanagingchronicpainconditions(Al-Ghanemetal.,2013).Therefore,itispossiblethattheuseofdexmedetomidineduringthyroidectomycouldhavelong-termbenefitsforpatientsbyreducingtheriskofchronicpainandimprovingqualityoflife.

Despitethepotentialbenefitsofdexmedetomidineinthyroidectomy,therearealsosomepotentialrisksandlimitationstoconsider.Forexample,themedicationcancausesideeffectssuchashypotension,bradycardia,andsedation,whichmaybeparticularlyproblematicinpatientswithcardiovasculardiseaseorothercomorbidities(Gengetal.,2015).Additionally,dexmedetomidineisarelativelyexpensivemedicationandmaynotbewidelyavailableinallhealthcaresettings.

Inconclusion,dexmedetomidinemaybeausefulmedicationforimprovingthesafetyandcomfortofpatientsundergoingthyroidectomy.Theavailableevidencesuggeststhatdexmedetomidinecanreducetheincidenceofcoughingandimprovepainreliefduringtheimmediatepostoperativeperiod.Futurestudiesareneededtoexploretheoptimaldoseanddurationofdexmedetomidineadministration,aswellasitspotentiallong-termbenefitsandlimitations.Nonetheless,theuseofdexmedetomidineinthyroidectomyrepresentsapromisingareaofresearchandclinicalpracticeforimprovingpatientoutcomesinthisimportantsurgicalprocedureFurthermore,dexmedetomidinehasalsoshownpotentialinreducingtheincidenceofdeliriumandimprovingcognitivefunctionpostoperativelyinelderlypatientsundergoingnon-cardiacsurgery.AstudyconductedbySuetal.foundthatdexmedetomidinereducedtheincidenceofpostoperativedeliriumandimprovedcognitivefunctionscorescomparedtothosewhoreceivedpropofolsedationalone(Suetal.,2016).Similarly,anotherstudyshowedthatintraoperativedexmedetomidineinfusionsignificantlyreducedtheincidenceofpostoperativecognitivedysfunctioninelderlypatientsundergoingmajorabdominalsurgery(Zhangetal.,2016).

Thepotentialbenefitsofdexmedetomidineextendbeyondtheimmediatepostoperativeperiod.Studieshaveshownthatdexmedetomidinecanalsoreducetheincidenceofpostoperativenauseaandvomiting(PONV)andimprovetheoverallqualityofrecoveryinpatientsundergoingsurgery.AstudyconductedbyLiangetal.foundthatdexmedetomidinereducedtheincidenceofPONVandimprovedthequalityofrecoveryinpatientsundergoinglaparoscopiccholecystectomycomparedtothosewhoreceivedpropofolsedationalone(Liangetal.,2017).Anotherstudyshowedthattheuseofdexmedetomidineintheperioperativeperiodimprovedthequalityofrecoveryandreducedthelengthofhospitalstayinpatientsundergoingspinalsurgery(Wangetal.,2017).

Despitethepotentialbenefits,theuseofdexmedetomidineinclinicalpracticeisnotwithoutlimitations.Oneofthemainconcernswithdexmedetomidineisitspotentialtocausehypotensionandbradycardia,especiallywhenadministeredathighdosesorinpatientswithpre-existingcardiacconditions.Therefore,closehemodynamicmonitoringisrequiredwhenusingdexmedetomidineinclinicalpractice.Anotherpotentiallimitationisthecostofdexmedetomidine,whichmaynotbefeasibleforcertainpatientpopulationsorhealthcaresystems.

Inconclusion,dexmedetomidinerepresentsapromisingareaofresearchandclinicalpracticeinimprovingpatientoutcomesinavarietyofsurgicalprocedures.Itspotentialbenefitsincludereducingtheincidenceofcoughing,delirium,PONV,andimprovingpainrelief,cognitivefunction,ando