右美托咪定用于老年患者全身麻醉拔管期时的气道和心血管反应的观察

Effect of Dexmedetomidine during Tracheal Extubation in Elderly Patients under General Anesthesia

目的:探讨右美托咪定(dexmedetomidine,Dex)对老年患者全身麻醉拔管期气道和心血管反应的影响。方法:将50例行胆囊切除术、ASA I^II级的老年患者随机分为Dex组(A组)和对照组(B组),每组各25例。A组和B组于全身麻醉诱导时分别静脉泵注Dex和咪唑安定。观察并记录两组患者于入室时(T1)、拔管前(T2)、拔管后1min(T3)、拔管后15min(T4)时的收缩压(SBP)、舒张压(DBP)、心率(HR)、脉搏血氧饱和度(SpO2)以及呛咳情况。结果:在T4时,A组患者SBP、DBP及HR明显低于B组(P<0.05)。A组拔管期呛咳等级为I+II级的患者占该组患者的88%,明显高于B组(56%),P<0.05;A组中出现严重呛咳反应(III+IV级)的患者(12%)显著少于B组(44%),差异有统计学意义(P<0.05)。结论:Dex可以减轻老年患者全身麻醉拔管时的气道和心血管反应。

Objective：To investigate the effect of dexmedetomidine on airway and cardiovascular reactions during tracheal extu bation in elderly patients under general anesthesia. Methods：Fifty ASA I or II elderly patients aged 60-75 years who were un dergoing laparoscopic cholecystectomy were randomly divided into dexmedetomidine group （Group A） and control group （Group B）, with twenty-five patients in each group. Patients in Group A were administered with dexmedetomidine at a dose of 1μg/kg at the beginning of the operation, while those in Group B were administered with midazolam at a dose of 150 μg/kg via micropumps. The systolic blood pressure （SBP）, diastolic blood pressure （DBP）, heart rate （ HR）, pulse oxygen saturation （SpO2） and the occurrence of cough were recorded at the time of baseline （T1）, during extubation （T2）, 1 minute after extu bation （T3）, 15 minute after extubation （T4）. Results： At the time of T4, the SBP, DBP and HR in Group A were signifi- cantly lower than those in Group B（P〈0. （15）. In Group A, SBP and DBP at T2 （P〈0.0l） and T3 （P〈0.05） were significant- ly higher than those at T4, and HR at T4 was significantly lower than that at T1, T2 and T3 （P〈0.05）. The percentage of patients whose cough grades were I and II during tracheal extubation in Group A （88%）was significantly higher than that in Group B （56%） （P〈0 05）; Serious choking cough response in Group A was also significantly reduced than that in Group B （P〈0 05）. Conclusions： Dexmedetomidine can relieve the airway and cardiovascular reactions of elderly patients with decannu- lation under general anesthesia.