右美托咪定在老年患者全髋关节置换手术中的应用

Application of dexmedetomidine in the aged patients with total hip replacement surgery

目的探讨盐酸右美托咪定在老年患者全髋关节置换手术中的临床应用。方法全身麻醉下全髋关节置换手术老年患者60例(年龄65～80岁),ASAⅡ级,随机均分为盐酸右美托咪定组(D组)和0.9%氯化钠注射溶液组(C组)。试验组患者术前(15 min内)给予盐酸右美托咪定0.6μg/kg及术中0.2μg·kg-1·h-1静脉持续泵注直至手术结束,对照组给予同等剂量的0.9%氯化钠注射溶液,并在不同时间点观察患者平均动脉血压(MAP)、心率(HR)、呼吸频率(RR)、脉搏血氧饱和度(SpO2)等血流动力学指标、Ramsay评分及苏醒期躁动的发生率。结果盐酸右美托咪定镇静效果良好,0.6μg/kg盐酸右美托咪定持续泵入时可引起患者一过性血压上升及窦性心动过缓。术后D组患者苏醒期躁动发生率明显低于C组,而Ramsay评分明显高于C组(P<0.05)。结论盐酸右美托咪定应用于老年患者全髋关节置换手术全身麻醉时显现出维持血流动力学稳定及良好的镇静效果。

Objective To explore the application of dexmedetomidine administered in the aged patients with total hip replacement surgery in aged patients.Methods A total of 60 ASA II patients,aged 65 ~80 years,scheduled for total hip replacement surgery Under the general anesthesia were allocated randomly to either dexmedetomidine group (group D)or normal saline group (group C),withn =30 cases in each group.Anesthesia was induced with dexamethasone 10 mg,etomidate 0.2 mg/kg,sufentanil 0.3 μg/kg,rocuronium 0.6 mg/kg.After induction anesthesia was injected continuous intravenous propofol 1 ~1.5 mg/L and sufentanil 0.5 ~0.8μg·kg -1 ·h -1 ,discontinuous suction sevoflurane maintain appropriate anesthesia depth.A gastric tube was inserted througu the drain tube of LMA. Group D patients before the induction of anesthesia,intravenous dextromethorphan prop microphone pyridine (Jiangsu Hengrui Pharmaceutical Company,Lot No.1,112,111)0.6μg/kg (15 min),and then changed to 0.2μg·kg -1 · h -1 until the end of surgery,group C injected with normal saline.SBP,DBP,HR,Ramsay and the incidence of agita-tion were recorded immediately before anesthesia(T0),5 min after the drug(T1),15 min after the drug (T2),30 min after the drug (T3),60 min after the drug(T4),at the end of the surgery (T5)and 30 min after pulling out LMA. Results The sedation of dexmedetomidine was effective at a 0.6 μg/kg dose of continuous dexmedetomidine infu-sioncould lead to elevated blood pressure and bradycardia.The incidence of EA was lower,and the Ramsay score was higher in group D than that in group C(P <0.05)after operation.Conclusions Dexmedetomidine administered in the aged patients during total hip replacement surgery could maintain hemodynamic stability and performed sedative effect.