右美托咪定对老年高血压患者全身麻醉拔管期心血管反应的影响

Effects of dexmedetomidine during the extubation period of general anesthesia in elderly patients with hypertension

目的:探究右美托咪定对老年高血压患者全身麻醉拔管期心血管反应的影响。方法:将60例行腹部手术的老年高血压患者随机分成两组,其中一组为试验组,在气管拔管前30分钟为试验组患者使用右美托咪定,另外一组为对照组,在气管拔管前30分钟为对照组患者使用生理盐水。分别记录两组患者用药前(T0)、拔管时(T1)、拔管后5分钟(T2)、拔管后10分钟(T3)的心率(HR)和平均动脉压(MAP)。同时,在拔管前和拔管后的5分钟分别采集两组患者的静脉血并用高效液相色谱法测定其血浆中的肾上腺素(E)含量和去甲肾上腺素(NE)含量。结果:两组患者拔管前的平均动脉压和心率无明显差异(P>0.05);对照组患者拔管时和拔管后5分钟的心率和平均动脉压均明显高于拔管前;试验组患者拔管时和拔管后5分钟的心率和平均动脉压亦高于拔管前,但明显低于对照组患者拔管时和拔管后5分钟的心率和平均动脉压,且两组间的差异具有统计学意义(P<0.05)。两组患者拔管前的血浆肾上腺素含量和去甲肾上腺素含量无明显差异(P>0.05);试验组患者拔管后5分钟的血浆肾上腺素含量和去甲肾上腺素含量明显低于对照组患者,且两组间的差异具有统计学意义(P<0.05)。结论:老年高血压患者在拔管期使用治疗剂量的右美托咪定可以有效降低拔管期不良反应的发生率,确保老年高血压患者的手术安全。

Objective To investigate the effects of dexmedetomidine during the extubation period of general anesthesia in elderly patients with hypertension receiving abdominal surgery.Methods Sixty elderly patients with hypertension receiving abdominal surgery were randomly divided into dexmedetomidine group and control group.The mean artery pressure（MAP）and heart rate（HR） were recorded before drugs injection,during extubationg,at 5 minutes and 10 minutes after extubation.Norepinephrine and epinephrine of serum were detected at before extubation and 5 minutes after extubation.Results In the control group,MAP and HR were significantly higher at extubation and 5 minute after extubation compared to pre-injection and dexmedetomidine group（P0.05）.The E and NE of Dexmedetomidine group were significantly lower than the control group at 5 minutes after extubation（p0.05）.Conclusions Dexmedetomidine can inhibit the cardiovascular responses of elderly hypertensive surgery patients during extubation and reduce the risk of surgery.