右美托咪定复合依托咪酯脂肪乳在老年患者全身麻醉中的应用

Clinical evaluation of dexmedetomidine combined with etomidate for general anesthesia of elderly patients

目的：观察右美托咪定复合依托咪酯脂肪乳用于老年患者全身麻醉的临床效果及安全性。方法选择美国麻醉师协会（ASA）分级Ⅰ---Ⅱ级全麻下行腹腔镜手术的老年患者60例，随机分为三组（n =20）：右美托咪定＋依托咪酯组（A 组）、依托咪酯组（B 组）、异丙酚组（C 组）。记录三组术中各时间点平均动脉压（MAP）、心率（HR）和血氧饱和度（SpO2）。记录停药后患者自主呼吸恢复时间、苏醒时间、拔管时间、定向力恢复时间，患者离开手术室前进行 Steward 苏醒评分。记录术中麻醉药用量及不良反应发生情况。结果三组术中血流动力学均维持平稳，MAP、HR 差异无统计学意义（ P ﹥0.05）。三组患者手术时间、自主呼吸恢复时间、苏醒时间、拔管时间、定向力恢复时间比较，差异均无统计学意义（ P﹥0.05）。三组患者出室前 Steward 苏醒评分均大于4分，A 组患者均安静合作，发生诱导时肌颤1例、术后寒颤1例；B 组发生诱导时肌颤6例、术后躁动3例、术后寒颤4例；C 组发生注射痛7例、术后躁动2例、术后寒颤5例。A 组瑞芬太尼及七氟醚平均每小时用量较 B、C 组显著降低（ P 〈0.05）。结论右美托咪定复合依托咪酯可安全用于无肾上腺皮质功能低下的老年患者的麻醉，有利于维持血流动力学稳定，减少麻醉用药及围术期不良反应的发生。

Objective To investigate the safety and efficacy of dexmedetomidine combined with etomidate for general anesthesia of elderly patients. Methods Sixty ASA Ⅰ～Ⅱ elderly patients undergoing laparoscopic surgery under general anesthesia were randomly divided into 3 groups （n = 20 each）：the group of dexmedetomidine combined with etomidate（group A）;the group of etomidate（group B）;the group of propofolum （group C）. MAP,HR and SpO2 were recorded at different times. Recovery from anesthesia,the dose of anesthetics and the adverse reactions was recorded as well. Results Patients in all three groups had stabilized hemodynamics. There were no significant differences in the recovery time,e-mergence time and extubation time among the three groups. In patients with adverse reactions amyostasia was found in 1 and rigors in 1 in group A;restlessness in 3,amyostasia in 6 and rigors in 4 in group B;and restlessness in 2,injection pain in 7 and rigors in 5 in group C. The average dose per hour of sufentanil and sevoflurane in group A were significantly lower than in group B and C. Conclusion Dexmedetomidine combined with etomidate can effectively maintain hemodynamics steadily,reduce the dose of anesthetics and the adverse reactions,and can be used safely for gen-eral anesthesia in elderly patients without hypoadrenocorticism.