右美托咪定在心功能不全的老年患者纤支镜检查中的应用

Application of dexmedetomidine in elderly patients with heart failure during fiber optic bronchoscope check-up

目的：探讨心功能不全的老年患者行纤支镜检查时使用右美托咪定的镇静效果.方法：采用前瞻性研究,连续收集2013年1月至2014年12月四川省人民医院ICU收治的123例心功能不全合并肺部感染需行纤支镜检查的老年患者作为研究对象,随机分为A组（右美托咪定治疗组）和B组（丙泊酚治疗组）,A组以右美托咪定注射液0.5 μg·kg-1为首剂量,0.5～1μg·（kg·h）-1为维持剂量;B组以丙泊酚1～1.5 mg·kg-1为首剂量,2～4 mg·（kg·h）-1为维持剂量实施镇静.比较两组患者在未给药物前（T0）、纤支镜抵达隆突即刻（T1）、纤支镜在气管内10 min（T2）、检查结束时（T3）平均动脉压（MAP）、经皮血氧饱和度（SPO2）、心率（HR）、呼吸频率（RR）、心率收缩压乘积（HPP）的变化;记录各点ST段及T波变化,评价心肌缺血、缺氧的程度;同时观察患者呼吸抑制、心律失常、体动、呛咳、喉痉挛等不良反应情况.结果：A组纳入64例,B组纳入59例,两组患者基线资料无统计学差异.T1、T2、T3时B组MAP、HPP值高于A组,T2和T3点的B组HR高于A组,差异有统计学意义（P＜0.05）;T1和T2点B组心电图ST段阳性变化发生率高于A组（P＜0.05）;A组呛咳、喉痉挛的发生率明显低于B组（P＜0.05）.结论：对于心功能不全的老年患者,以右美托咪定镇静实施纤支镜检查血流动力学更平稳,麻醉效果显著提高.

Objective： To investigate the anesthetic effect of dexmedetomidine in elderly patients with heart failure during fiber op- tic bronchoscope check-up. Methods： A prospective control study was conducted from January 2013 to December 2014, and 123 eld- erly patients with heart failure and pulmonary infection who need fiber optic hronchoscope check-up in the ICU unit of Sichuan Pro- vincial People＇s Hospital. The Patients were divided into dexmedetomidine group（A） and propofol group（B） randomly 0.5 g kg-1 dexmedetomidine injection was given to patients at first, and 0.5 - 1 μg · （kg ·h）-1 was given continuous in A group. 1 -1. 5 mg · kg-1 propofol injection was given at first, and 2~4mg · （kg · h）-i was given continuous in B group. MAP, SpO2, HR, RR, HPP, the change of ST and T were recorded before examine（T0）, immediately after bronchoscopy into earina（T1）, 10 rain into the trachea（T2） and the time after examine（T3）. At the same time, the adverse reaction was record between two groups, Results.. The A group is 64 patient and the B group is 59 patient, the baseline in two groups was consistent（P》0. 05）. On B group, the indi- cators of MAP, HR, HPP were higher at TI, T2, T3 than T0（P〈0. 05） ;MAP, HPP were higher on the B group at T1, T2, T3 than A group, HR was higher on the B group at T2, T3 than A group（P〈0. 05） ; the variation of ST was more frequently on the B group at T1 and T2（P〈0.05） ; the incidence of bucking,laryngospasm was less on the A group（P〈0. 05）. Conclusions： The appli- cation of dexmedetomidine is better for cyclical stabilization and anesthesia on elderly patients with heart failure during fiber optic bronchoseope check-up.