右美托咪定对老年患者全身麻醉手术血流动力学和苏醒期拔除气管导管的影响

Effects of dexmedetomidine on hemodynamics and extubation during recovery period from general anesthesia in elderly patients

目的探讨术前应用右美托咪定对老年患者全身麻醉手术血流动力学和苏醒期拔除气管导管的影响。方法选择全身麻醉下择期行髋部骨折手术的患者60例,年龄60～85岁,体重50～85kg,美国麻醉医师协会（ASA）分级Ⅱ或Ⅲ级。随机分入右美托咪定组和对照组,每组30例。右美托咪定组患者经静脉输液泵注射右美托咪定0.5μg/kg,注射时间为15 min,对照组患者经静脉输液泵注射等容量的0.9%氯化钠溶液。分别于给药前（T0）、经静脉输液泵注射药物10 min（T1）、经静脉输液泵注药物结束（T2）、气管插管后即刻（T3）、手术切皮（T4）、手术进行30 min（T5）、手术结束（T6）、拔除气管导管后5 min（T7）、拔除气管导管后30min（T8）各时间点监测患者的平均动脉压（MAP）和心率（HR）,记录患者自主呼吸恢复、按指令睁眼、拔除气管导管的时间和脑电双频指数（BIS）值。结果右美托咪定组在T4、T5、T6时间点的MAP和HR均显著低于同组T0时间点（P值均〈0.05）;对照组在T3时间点的MAP和HR均显著高于同组T0时间点（P值均〈0.05）,T4、T5、T6时间点的MAP和HR均显著低于同组T0时间点（P值均〈0.05）。对照组在T3和T7时间点的MAP和HR,以及T4时间点的HR均显著高于右美托咪定组同时间点（P值均〈0.05）。右美托咪定组自主呼吸恢复时的BIS值显著高于对照组（P〈0.05）,两组间自主呼吸恢复时间、按指令睁眼时间和BIS值、拔除气管导管时间和BIS值的差异均无统计学意义（P值均〉0.05）。右美托咪定组术中丙泊酚和芬太尼用量均显著低于对照组（P值均〈0.05）。两组间心动过缓和低血压发生率的差异均无统计学意义（P值均〉0.05）。结论老年患者在行髋部手术前静脉输注0.5μg/kg右美托咪定能使其围术期血流动力学更加平稳,且对术后苏醒和拔除气管导管无影响。

Objective To explore the effects of preoperative application of dexmedetomidine （DEX） on the hemodynamics and extubation during recovery period from general anesthesia in elderly patients. Methods Sixty patients （aged 60-85 years, weighing 50--85 kg, American Society of Anesthesiologists class Ⅱ or Ⅲ ） undergoing elective hip-fracture operation under general anesthesia were randomly divided into DEX group and control group （n = 30）. DEX （0.5μg/kg） and normal saline were injected, in the two groups by venous pump for 15 min before surgery respectively. Mean arterial pressure （MAP） and heart rate （HR） were recorded before drug infusion （To）, at 10 min after drug infusion （T1）, at the end of drug infusion （T2）, immediately after intubation （T3）, at the time of skin-cutting （T4）, at 30 rain of surgery （T5）, at the end of surgery （T6）, at 5 min （T7） and 30 min after extubation （T5）. The time and bispectral index score （BIS） were also recorded at spontaneous respiration recovery, eyes-opening on verbal command and extubation. Results In the DEX group, MAP and HR at T4, T5 and T6 were significantly lower than those at To （all P〈0. 05）. In the control group, MAP and HR at T3 were significantly higher than those at To （both P〈0.05）, while MAP and HR at T4, T5 and T6 were significantly lower than those at To （all P〈0.05）. MAP and HR at T3 and T7 and HR at T4 in the control group were significantly higher than those in the DEX group （all P〈0.05）. The BIS in the DEX group was significantly higher than that in the control group when autonomous breathing recovered （ P〈0, 05）. The total consumption of propofol and fentanil in the DEX group were significantly lower than those in the control group （both P 〈 0. 05）. There were no significant differences in terms of spontaneous respiration recovery time, eyes-opening on verbal command time or BIS, extubation time or BIS between two groups （all P〉0.05）. Neither was the incidence of bradycardia nor hypotension （both P 〉 0. 05）. Conclusion Application of 0. 5 μg/kg dexmedetomidine in elderly patients undergoing hip operation can make perioperative hemodynamics more stable, and does not affect the awakening and extubation.