右美托咪定预防老年高血压患者全麻气管插管及拔管时心血管反应的研究

Study of dexmedetomidine on prevention of the cardiovascular response during intubation and extubation in old aged patients with hypertension in general anesthesia

目的探讨右美托咪定(dexmedetomidine,Dex)用于老年高血压患者全麻期间预防气管插管和拔管时心血管反应的临床效果及安全性。方法选择80例在本院行外科手术ASAⅡ~Ⅲ级伴高血压老年患者,随机双盲分为A(观察)组(n=40,气管插管前静注0.5μg/kg Dex)和B(对照)组(n=40,气管插管前静注等量0.9%NS)。记录两组患者麻醉诱导前(T0)、诱导后5 min(T1)、插管后即刻(T2)、插管后2 min(T3)、拔管后即刻(T4)、拔管后2 min(T5)等时点的HR、SBP、DBP、SpO2的变化;观察两组麻醉时间、拔管时间、患者在PACU1h内意识状态、麻醉合并症及不良反应。结果两组患者麻醉时间、拔管时间差异无统计学意义。两组T1及A组其它时间点HR、SBP和DBP与T0比较明显降低(P<0.01);B组在T2、T3、T4和T5等各时点HR、SBP、DBP比T0及A组明显地升高(P<0.05,P<0.01)。在T4和T5时患者呛咳、体动的发生A组(17.5%)明显少于B组(47.5%);安静入睡者A组(62,5%)显著高于B组(15%)。两组其它合并症及不良反应发生率差异无统计学意义(P>0.05)。结论 Dex可安全静脉泵注用于全麻老年高血压患者,能有效地预防气管插管和拔管时的心血管反应。

Objective To investigate the clinical effects and safety of dexmedetomidine （Dex） on prevention of the cardiovascular response during intubation and extubation in old aged patients with hypertension in general anesthesia. Methods 80 elective old aged patients with hypertension, ASA grade II~ m, undergoing surgery under general anesthesia were double-bllnded randomly allocated to two groups with 40 cases each. Group A （n = 40） received Dex 0.5 la^Jkg and group B （n=40） received the same volume normal saline. HR, SBP, DBP were recorded before anesthesia （To）, after induction （T1）, at the time of intubation（T2）, 3 rain after intubation （T3）, at the time of extubation （T4） and 3 rain after extubation （Ts）. The complications and adverse reactions of anesthesia were recorded during each operation, anesthetic time, extubation time and patients＂ consciousness in 1 hour during PACU were observed and recorded. Results Anesthetic time and extubation time were not significantly different in the two groups （P〉0.05）. HR, SBP, DBP were found significantly lower than baseline at the time of T1 in both groups and at other time point in group A （P〈0.O1）.HR, SBP, DBP were significantly higher than To and group A at each point of T2, T3, T4 and T~ in group B （P〈0.05 or P〈0.01）. The patients＇ choke and body movement in group A （17.5%） were found ~ignificantly lower than those in group B（47.5%）. Quiet fall asleep cases were found significantly higher in group A （62.5%） than that in group B （15%）. The incidence of complications and adverse reactions in both groups ware not significant （P〉0.05）. Conclusion It is safety to pump intravenous injection Dex for old aged patients with hypertension undergoing surgery in general anesthesia. It can be effective in preventing cardiovascular response during intubation and extubation.