脑电双频指数监测下右美托咪定用于老年患者术中知晓的研究

Study of dexmedetomidine under monitoring of bispectral index on intraoperative awareness in elderly patients

目的研究在脑电双频指数监测下右美托咪定用于老年患者术中知晓的情况。方法选取择期行股骨干骨折切开复位内固定老年患者60例,随机分为右美托咪定组（D组）和咪达唑仑组（M组）,每组30例。记录两组给药后（T1）、气管插管后（T2）、手术开始后30 min（T3）、手术结束时（T4）的心率（HR）、收缩压（SBP）、舒张压（DBP）;在脑电双频谱保持同等状态下（50～60之间）比较术中丙泊酚维持用量和苏醒期躁动情况;术后第3天对患者问卷调查,评价术中知晓的发生。结果 T2、T3、T4时D组较M组HR降低明显（P〈0.05）,SBP、DBP均低于M组（P〈0.05）;D组丙泊酚维持用量明显少于M组（P〈0.05）,D组苏醒时躁动发生率明显低于M组（P〈0.05）。结论右美托咪定复合麻醉可以维持血流动力学稳定,有效地避免术中知晓的发生,提高苏醒期质量。

Objective To study dexmedetomidine under monitoring of bispectral index （BIS） on intraoperative awareness in elderly patients. Methods 60 elderly patients who would accept open reduction and internal fixation due to fracture of femoral shaft in a proper time were selected,and were evenly divided into dexmedetomidine group （group D） and midazolam group （group M） in random.Heart rate （HR）,systolic blood pressure （SBP）,and diastolic blood pressure （DBP） were recorded after medication （T1）,trachea cannula （T2）,3Omin of operation starting （T3）,and operation ending （T4）.Dosage maintaining of propofol in operation and dysphoria during analepsia in the two groups were compared under the same condition of BIS （50-60）.Questionnaires were distributed to these participants in the third day after surgery in order to evaluate the occurrence of intraoperative awareness. Results The HR in group D at T2,T3,and T4 decreased more obviously than that in group M （P〈0.05）.SBP and DBP in group D was lower than that in group M （P〈0.05）.In group D,dosage maintaining of propofol was less than that in group M （P〈0.05）.Frequency of dysphoria occurring during analepsia in group D was also greatly less than that in group M （P〈0.05）. Conclusion Dexmedetomidine combined with anesthetics can maintain stabilization of hemodynamics,effectively avoid the occurrence of intraoperative awareness,and improve patient＇s quality during recovery period.