右美托咪定对老年患者胸科手术麻醉苏醒期不良反应的预防作用

Preventive effect of dexmedetomidine on adverse reactions during recovery from general anesthesia in elderly patients undergoing thoracic surgery

目的:观察右美托咪定对老年患者胸科手术麻醉苏醒期的影响。方法:将40例老年胸科手术患者随机分成2组:生理盐水组(N组)和右美托咪定组(D组)。观察并记录两组患者苏醒期咳嗽和不自主运动发生情况以及血流动力学的变化。记录拔管时间、苏醒后5 min疼痛程度(VAS)、血管活性药物使用次数。结果:吸痰拔管时、拔管后5 min,N组的HR和MAP与给药前比较明显升高(P<0.05),同监测时点与D组比较差异有统计学意义(P<0.05);与N组相比,D组咳嗽发生率和严重程度均明显减轻,不自主运动发生率降低,VAS评分降低(P<0.05或P<0.01);D组乌拉地尔及艾司洛尔的使用次数低于N组(P<0.05),两组拔管时间差异无统计学意义(P>0.05)。结论:应用右美托咪定能降低老年患者胸科手术麻醉苏醒期咳嗽发生率以及严重程度,降低不自主运动的发生,有效维持血流动力学平稳而且也不延长拔管时间。

Objective： To observe the effect of dexmedetomidine on post-anesthesia recovery in elderly pa- tients with thoracic surgery. Methods： A total of 40 patients during thoracic surgery were enrolled, randomly assigned to 2 groups, and treated with saline （n = 20, control） and dexmedetomidine （n = 20）. Coughing, involuntary movement and hemodynamic changes were recorded during the recovery from general anesthesia. Time to tracheal extubation, visual analogue scale （VAS） after emergence from anesthesia, and dosage of vasoactive drugs were recorded. Results： In control group, MAP and HR were significantly increased at tracheal extubation and 5 rain after tracheal extubation compared to baseline values and those in dexmedetomidine group （P 〈 0.05）. In dexmedetomidine group, the incidence and severity of coughing, incidence of involuntary movement, and VAS score were significantly decreased（P 〈0.05 or P 〈0.01 ）. The number of uses of urapidil and esmolol was significantly lower in dexmedetomidine group than in control group （P 〈 0.05）. There was no significant difference in the tracheal extubation time between two groups （ P 〉 0.05 ）. Conclusion ： Dexmedetomidine does not prolong tracheal extubation time, but reduces the incidence and severity of coughing and maintains stable hemodynamics during recovery from general anesthesia in elderly patients undergoing thoracic surgery.