右美托咪啶对老年高血压患者全身麻醉诱导期血流动力学的影响

Effects of dexmedetomidine on hemodynamics during general anaesthetic induction of elderly patients with hypertension

目的探讨老年高血压患者全身麻醉诱导期应用右美托咪啶对血流动力学的影响。方法选取我院2010年1月~2014年12月收治入院的择期手术全身麻醉的老年高血压患者200例,随机分为观察组和对照组,每组100例,对照组100例患者常规给药,观察组100例患者在常规给药基础上给予右美托咪啶。观察麻醉开始前（T0）、输注右美托咪啶后（T1）、全麻诱导后（T2）、气管插管后1min（T3）、3min（T4）、5min（T5）患者收缩压、舒张压、心率、心率收缩压乘积（RPP）的变化。以及两组患者血管活性药物的使用次数,并进行统计学分析。结果观察组在T1时心率开始下降,T2、T3、T4、T5时的心率与T0时、对照组同时间段比较,差异有统计学意义（P〈0.05）;对照组在T2时HR下降,与T0时比较差异有统计学意义（P〈0.05）。在T3、T4和T5时,两组收缩压无明显变化,两组在T2时均较T0时下降,差异有统计学意义（P〈0.05）,但观察组下降程度小于对照组,差异有统计学意义（P〈0.05）。观察组T2、T5时两组舒张压与T0时比较均下降（P〈0.05）,观察组下降程度小于对照组,差异有统计学意义（P〈0.05）。观察组T1、T2、T3、T4、T5时RPP与T0时比较均下降（P〈0.05）,观察组T1、T3、T4、T5时RPP与对照组同时间段比较均下降（P〈0.05）,对照组在T2、T5时RPP下降,与T0时比较差异有统计学意义（P〈0.05）;观察组应用阿托品4例,麻黄素4例,硝酸甘油2例,总使用率为10.0%;对照组应用阿托品3例,麻黄素6例,硝酸甘油3例,总使用率12.0%;两组比较差异无统计学意义（P〉0.05）。结论右美托咪定在老年高血压患者的麻醉诱导中,能够为维持麻醉诱导时血流动力学的稳定性,有效抑制气管插管时的心血管反应。

Objective To explore Effects of dexmedetomidine on hemodynamics during general anaesthetic induction of elderly patients with hypertension. Methods 200 elderly patients with hypertension who were admitted to our hospital and received general anesthesia in operations from January 2010 to December 2014 were randomly allocated to the observation group and the control group, with 100 in each. 100 patients in the observation group were given routine drugs while 100 patients in the control group were given dexmedetomidine at the basis of routine drugs. Systolic blood pressure, diastolic blood pressure, heart rate and rate pressure product（RPP） before anesthesia（T0）, after infusion of dexmedetomidine（T1）, after general anaesthetic induction（T2）, 1min（T3）、3min（T4）、5min（T5） after tracheal intubation of patients were observed. In addition, using times of vasoactive drugs of patients in two groups were observed and analyzed statistically. Results Heart rate of the observation group was decreased at T1. Differences between heart rate at T2, T3, T4 and T5 and heart rates at T1 had statistical significance（P〈0.05）. In addition, Differences between heart rate at T1, T2, T3, T4 and T5 of the observation group and of the control group had statistical significance（P〈0.05）. HR of the control group was decreased at T2 and difference had statistical significance compared with HR at T0（P〈0.05）. Systolic blood pressure of two groups at T3, T4 and T5 had no obvious changes. But systolic blood pressure of two groups at T2 was decreased compared with that at T1. Difference had statistical significance（P〈0.05）. But decreasing degree of the observation group was smaller than that of the control group and the difference had statistical significance（P〈0.05）. Diastolic blood pressure of two groups were both decreased at T2 and T5 compared with that at T0（P〈0.05）. But decreasing degree of the observation group was smaller than that of the control group and the difference had statistical significance（P〈0.05）. RPP at T1, T2, T3, T4 and T5 of the observation group were all decreased compared with that at T0（P〈0.05）. RPP at T1, T3, T4 and T5 of the observation group were all decreased compared with that at T1, T3, T4 and T5 of the control group（P〈0.05）. RPP of the control group were decreased at T2 and T5 and difference had statistical significance compared with RPP at T0（P〈0.05）. In the observation group, there were 4 cases of atropine, 4 cases of ephedrine and 2 cases of nitroglycerin. The total using rate was 10.0%. The difference between the two groups was not statistically significant（P〈0.05）. Conclusion Application of dexmedetomidine in anaesthetic induction of elderly patients with hypertension can maintain hemodynamic stability during induction and inhibit cardiovascular response to tracheal intubation effectively.