右美托咪定预处理对全麻诱导期老年患者双腔气管插管血流动力学的影响

Effects of Hemodynamics on Dexmedetomidine Pretreatment for Older Patients Undergoing Double Lumen Endotracheal Intubation in General Anesthetic Induction Period

目的：观察中等剂量右美托咪定（Dex）对行双腔气管插管单肺通气老年手术患者全麻诱导期麻醉深度指数和血流动力学的影响。方法：选择拟行术中单肺通气双腔气管插管老年手术患者40例，年龄60~75岁，随机数字表法分为D组（右美托咪定）和C组（对照），每组20例。D组麻醉诱导10 min前静脉泵注右美托咪定0.5μg/kg，C组麻醉诱导前静脉泵注等量生理盐水。泵注之后两组均采用常规麻醉诱导，记录两组泵注前（T0）及泵注后2 min（T1）、4 min（T2）、6 min（T3）、8 min（T4）、10 min（T5）、插管前（T6）、插管后即刻（T7）麻醉深度指数（CSI）、DBP、MAP、HR各指标变化。结果：D组T4（65.4±10.4）、T5（60.3±7.9）、T6（46.1±4.7）与T0（96.5±4.0）比较，CSI逐渐下降（P〈0.05），且显著低于C组（P〈0.05）；D组T5、T6与T0比较，HR明显减慢（P〈0.05）；C组T7与T6比较，DBP、MAP、HR均有升高（P〈0.05）。结论：麻醉诱导前右美托咪定以0.5μg/kg剂量缓慢输注对老年单肺通气手术患者产生明显镇静效应，能够明显减轻麻醉诱导期双腔气管插管操作与定位对老年手术患者的心血管应激反应。

Objective：To observe effects of hemodynamics on Dexmedetomidine pretreatment for thoracic surgery in older individuals via double lumen endotracheal intubation in General anesthetic induction period. Method：Forty ASAⅠ-Ⅲpatients with thoracic surgery were randomly divided into two groups：Group C（control group,n=20）and Group D（dexmedetomidine group D,n=20）. In the group D,Dexmedetomidine was intravenously administered at 0.5μg/kg for ten minutes. The patients in Group C were stated on 0.9%normal saline infusion at an equivalent rate. Drug induced using midazolam 0.02 mg/kg,fentanyl 4μg/kg,vecuronium bromide 0.1 mg/kg and etomidate 0.3 mg/kg. Changes of cerebral state index（CSI）,heart rate（HR）,systolic blood pressure（SBP）,diastolic blood pressure（DBP）,mean arterial pressure（MAP）were monitored before injection（T0）,after injection at 2 minutes（T1）,4 minutes（T2）,6 minutes（T3）,8 minutes（T4）,10 minutes（T5）,before intubation（T6）,immediately after intubation（T7）. Result：The CSI in Group D of T4（65.4±10.4）,T5（60.3±7.9）,T6（46.1±4.7）gradually decreased compared with the T0（96.5±4.0）（P〈0.05）,and was significantly less than that of Group C（P〈0.05）,the HR in Group D of T5,T6 significantly decreased compared with the T0（P〈0.05）. DBP,MAP,HR of T7 in Group C were higher than those of T6（P〈0.05）during anesthetic induction. Conclusion：Dexmedetomidine pretreatment at 0.5μg/kg for ten minutes has obvious sedative effect for elderly patients,not only can make CSI decreased,but also can reduce the cardiovascular stress responses during double lumen endotracheal intubation.