右旋美托咪定对静吸复合全身麻醉行全髋置换术老年患者血流动力学及苏醒质量的影响

The influence of dexmedetomidine in the hemodynamic and analepsia quality of elderly patients with combined general anesthesia for total hip replacement

目的：评价右旋美托咪定对全麻下行全髋置换手术的老年患者血流动力学及苏醒质量的影响。方法选择2007年7月-2013年7月在本院接受全髋置换术的60例老年患者作为研究对象，分为观察组和对照组。患者上肢静脉通路后，观察组将0.4μg/kg负荷量右旋美托咪定采用微量泵从静脉10 min内泵入，维持量为0.3μg/（kg· h）；对照组将50 ml 0.9%NaCl溶液从静脉泵入，方法同观察组。分别记录患者入室（T0）、开始泵药（T1）、泵药10 min（T2）、切皮（T3）、切皮30 min（T4）、拔管（T5）、拔管后30 min（T6）的收缩压（SBP）、舒张压（DBP）、心率（HR）、脑功能状态指数（CSI）等参数，并记录患者苏醒时间、拔管时间及术后30 min警觉镇静（OAA/S）评分。结果观察组SBP、DBP、HR在T5、T6时点与对照组比较显著下降，差异有统计学意义（P〈0.05）；观察组CSI在T2-T6各时点与对照组比较差异均有统计学意义（P〈0.05）；观察组拔管时间、苏醒时间均显著短于对照组（P〈0.05），但OAA/S评分显著高于对照组（P〈0.05）。结论对全麻下行全髋置换术的老年患者术前给予右旋美托咪定可有效维持患者围手术期血流动力学稳定，缩短拔管时间和苏醒时间，维持OAA/S。

Objective To study the influence of dexmedetomidine （DEX） in the hemodynamic and analepsia quality of elderly patients with combined general anesthesia for total hip replacement, and to provide theoretical basis for its application in clinic. Methods From May, 2006 to May, 2013, 60 ASA Ⅰ-Ⅱ elderly patients undergoing total hip replacement with combined general anesthesia were randomly divided into the DEX treatment group and control group. The patients in the DEX treatment group were pumped with 0.3μg· kg-1· h-1 DEX. The patients in the control group were pumped with 0.9%NaCl. The systolic blood pressure （SBP）, diastolic blood pressure （DBP）, heart rate （HR） and cerebral state index （CSI） of patients in various group before administration （T0）, at the beginning of pump delivery （T1）, at 10 min after pump delivery （T2）, at the beginning of skin incision （T3）, at 30 min after skin incision （T4）, at extubation （T5）, 30 min after extubation （T6） were recorded. The wake-up time, extubation time and Observer’s Assesment of Alterness/sedation scores （OAA/S） at 30 min after operation. Results Compared with the control group, at T5, T6, the SBP, DBP and HR in the treatment group were descended significantly, there were statistically significant differences （P〈0.05）. Compared with the control group, The CSI at T2 to T6 in the the DEX treatment group were descended significantly, there were statistically significant differences （ P〈0.05）. Compared with the control group, the wake-up time, extubation time in the DEX treatment group were reduced significantly, and there were statistically significant differences （P〈0.05）. Compared with the control group, the OAA/S of patients in the DEX treatment group increased significantly, and there was statistically significant differences （ P〈0.05）. Conclusion The DEX treatment could stablize the hemodynamics indexes of elderly patients with general anesthesia during extubation, shorten the time of analepsia and extubation, and sustain OAA/S.