右美托咪啶及咪达唑仑计划镇静用于老年TURP患者的安全性评价

The safety evaluation of planned sedation using dexmedetomidine in elderly patients undergoing TURP

目的比较右美托咪啶和咪达唑仑计划镇静用于经尿道前列腺电切术(TURP)老年患者的围术期镇静效果及不良反应情况。方法 60例择期行TIURP的老年患者按照随机数字表法分为右美托咪啶组(D组)、咪达唑仑组(M组)及对照组(C组),每组20例。所有患者行腰硬联合麻醉后,D组给予右美托咪啶0.75μg/kg静脉泵注,M组给予咪达唑仑0.03mg/kg静脉泵注,C组给予等体积0.9%氯化钠溶液,于手术开始前10min开始输注。记录麻醉前(T_0)、给药完成后5min(T_1)、10min(T_2)、20min(T_3)、40min(T_4)、手术结束(T_5)和术后2h(T_6)患者的生命体征及脑电双频指数(BIS),随访患者围术期不良事件的发生情况。结果与T_0比较,3组患者T_(1-6)血压降低、心率减慢、鼓膜温度降低,M和D组T_(1-5)BIS值降低,M组T_2、T_3 SpO_2值降低(P<0.05)。与M组比较,D组患者严重心动过缓增加,而呼吸抑制和寒战发生率降低(P<0.05),两组高血压发生率增高差异有统计学意义(P<0.05),两组低血压发生率差异无统计学意义(P>0.05)。3组均未发生恶心或呕吐。结论 0.75μg/kg右美托咪啶适合TURP老年患者的围术期镇静,但术中要注意患者血流动力学变化。

Objective To compare the sedative effect and adverse reaction of dexmedetomidine and midazolam for planned sedation in patients undergoing transurethral resection of prostate （TURP）. Methods Sixty elderly patients scheduled for TURP were enrolled and allocated into three groups using random number table method, which were Group C, M and D, with 20 cases in each group. All the patients received combined spinal epidural anesthesia.10 rain before operation, intravenous in- jection of 0.75ug/kg dexmedetomidine using micropump was given in Group D, and 0.03mg/kg midazolam was administrated in Group M, while equal volume of 0.9% sodium chloride solution was given instead in Group C. Vital signs and bispeotra] index （BIS） values were colleted immediately before anesthesia （To）, 5 min （T1）, 10 min （T2）, 20 rain（T3）, 40 min （T4） after drug administra- tion, immediately（Ts） and 2 hours after operation ending（T6）. The adverse effects of different sedation program were followed up at 2 hours after operation, Results As compared to TO, mean blood pressure, heart rate and eardrum temperature were decreased at T1-6 in three groups, BIS values at T1-5 in both Groups M and D and SpO2 at T2-3 in Group M were decreased（P〈0.05）. The inci- dences of marked bradycardia, hypertension and xerostomia were increased, but the incidence of respiratory depression and chilling were decreased（P〈0.05）, no significant differences of hypotension incidence were found between D and M（P 〉0.05）. No patient complained nausea and vomit incidences throughout the study. Conclusion Dexmedetomidine is suitable for perioperative sedation in elderly patients undergoing TURP, however the changes in hemodynamics should be paid due attention.