盐酸右美托咪定用于老年晶体植入手术的临床观察

Clinical observation of dexmedetomidine on aged patient undergoing cataract extraction combined with intraocular lens implantation

目的比较不同剂量的右美托咪定(DEX)用于老年晶体植入术中的安全性和有效性。方法 ASAⅠ或Ⅱ级择期行晶体植入手术的老年患者92例,随机均分为低剂量右美托咪定组(D1组)、中剂量右美托咪定组(D2组)、高剂量右美托咪定组(D3组)、咪达唑仑组(M组)。D1组,DEX 0.4μg/kg,用生理盐水稀释成20mL,静脉泵注10min,D2组,DEX 0.7μg/kg,给药方法同D1组;D3组,DEX 1.0μg/kg,给药方法同D1组;M组手术开始前10min输注咪达唑仑0.03mg/kg。观察记录患者麻醉前(T0)、用药后10 min(T1)、15 min(T2)、30 min(T3)、60min(T4)平均动脉压(MAP)、心率(HR)、RR(呼吸次数)、血氧饱和度(SpO2)。同时观察三组术中、术后不良反应及医生和患者满意度。结果与麻醉前比较,D组患者MAP、HR有显著性差异(P<0.05)。D2、D3组术中体动发生率、术后谵妄的发生率、低于D1组(P<0.05)和M组(P<0.05)。D组医生和患者满意度高于M组(P<0.05)。结论中、高剂量右美托咪定应用于晶体植入手术患者安全有效;镇静镇痛效果好;术中、术后不良反应发生率低且医师和患者满意度高。

Objective To observe the safety and efficacy of dexmedetomidine on aged patients undergoing cataract extraction combined with intraocular lens implantation. Methods 92 patients （ASA Ⅰor Ⅱ）were randomly divided into four groups, with 23 cases in each group （n=23）, midazolam group （group M）low-dose DEX group （D1 group）, medium-dose DEX group（D2 group）, high-dose DEX group （D3 group）. MAP, HR, RR,SpO2 were recorded before anesthesia, after 10 min begin infusion of DEX and 15, 30 and 60 min At the same time, the degree of satisfaction of doctors and patients were recorded. Results In DEX groups, HR and MAP decreased significantly at T1-T3 compared with T0 （P 〈 0.05） . The incidence of adverse reaction was significantly lower in group D2 and group D3 Compared with group D1 （P〈0.05） and group M （P〈0.05）. At the times, the degree of satisfaction of doctors and patients Was higher than D1 group （P 〈0.05）, M group （P 〈0.01） . Conclusion Aged patients undergoing cataract extraction combined with intraocular lens implantation is safe and effective;Calm analgesic the effect for sedation and analgesia is good;The incidence of adverse reaction of perioperative and postoperative is lower and doctors and patients satisfaction is higher.