右美托咪啶剂量对诱导插管期老年高血压患者血流动力学的影响

Effects of different dose dexmedetomidine on hemodynamic for elderly hypertensive patients with general anesthesia during induction of anesthesia and intubation

目的观察诱导前泵注不同剂量右美托咪啶对气管插管期老年高血压患者血流动力学的影响。方法随机数字表法将全麻下择期手术的老年高血压患者分为四组：DEX高剂量组（DH组）、DEX中剂量组（DM组）、DEX低剂量组（DL组）和对照组（C组）,每组各20例患者。观察各组入室后（T0）、麻醉诱导前（T1）、插管前（T2）、插管后1min（T3）、插管后3min（T4）、插管后5min（T5）HR、SBP、DBP、MAP的变化,同时观察四组患者心血管不良事件的发生率。结果 T0时HR、SBP、DBP、MAP各组参数无统计学差异（P〉0.05）;T1时,各组HR、SBP、DBP、MAP和T0时相比均有所下降（P〈0.05）,DEX各组下降程度均高于C组（P〈0.05）,DM组和DL组无差异（P〉0.05）,DH组低于DM组和DL组且有差异（P〈0.05）;T2时,各组HR、SBP、DBP、MAP较T0下降（P〈0.05）,DEX各组SBP、DBP、MAP高于C组,差异有统计学意义（P〈0.05）,DH组高于DM组和DL组（P〈0.05）,DM和DL组无统计学意义（P〉0.05）;T3时,C组HR、SBP、DBP、MAP均较T0明显上升（P〈0.05）,DEX各组保持平稳,均低于C组,DH组低于DM组和DL组（P〈0.05）,DM组和DL组无统计学意义（P〉0.05）;T4时,C组HR、SBP、DBP、MAP和T0比均无统计学意义（P〉0.05）,DEX各组均低于T0组,DH组低于DM组和DL组,DM组和DL组无统计学意义（P〉0.05）;T5各组HR、SBP、DBP、MAP均较T0下降,均有统计学意义（P〈0.05）,但各组间比较无统计学意义（P〉0.05）。结论 0.4-0.8μg/kg剂量的DEX均可显著减轻老年高血压患者气管插管应激反应引发的心血管反应,维持患者的血流动力学稳定,0.8μg/kg的作用效果更强,建议在做好监护的前提下,采用高剂量0.8μg/kg。

Objective To observe the hemodynamic effect of pretreatment with different of dexmedetomidine on trachel intubation for elderly hypertensive patients with general anesthesia before induction. Methods 80 elderly hypertensive patients scheduled for elective surgery under general anesthesia were randomly divided into four groups：DEX high dose group（DH group）,DEX middle dose group（DM group）,DEX low dose group（DL group） and control group（C group） with 20 patients in each group.Systolic pressure（SBP）,distolic pressure（DBP）,mean arterial pressure（MAP） and heart rate（HR） were recorded after getting into operation room（T0）,before induction（T1）,before intutatoin（T2）,at 1 min（T3）,3min（T4） and 5min（T5） after intubation.Major adverse cardiovascular events of all patients were observed. Results HR,SBP,DBP and MAP at T0 among the four groups were not statistically significant（P〉0.05）.At T1,HR,SBP,DBP and MAP to patients in four groups were obviously decreased than those at T0（P〈0.05）,and group DH,DM,DL were all lower than those in group C（P〈0.05）,there were not statistically significant（P〉0.05） between group DM and DL,while group DH was lower than group DM and DL（P〈0.05）.At T2,HR,SBP,DBP and MAP to patients in four groups were obviously decreased than those at T0（P〈0.05）,and group DH, DM, DL were all higher than those in group C（P〈0.05）,there were not statistically significant（P〉0.05） between group DM and DL,while group DH was higher than group DM and DL（P〈0.05）.At T3, HR,SBP,DBP and MAP to patients in group C were obviously increased than those at T0（P〉0.05）,and group DH,DM, DL were lower than group C（P〈0.05）,there were not statistically significant（P〉0.05） between group DM and DL,while group DH was lower than group DM and DL（P〈0.05）.At T4,HR,SBP,DBP and MAP to patients in group C were not statistically significant than those at T0（P〈0.05）,and group DH,DM,DL were lower than at T0,there were not statistically significant（P〉0.05） between group DM and DL,while group DH was lower than group DM and DL（P〈0.05）.At T5,HR,SBP,DBP and MAP to patients in four groups were decreased than those at T0（P〈0.05）,but there were not statistically significant among four groups（P〉0.05）. Conclusion For elderly hypertensive patients DEX with dose of 0.4-0.8μg/kg can significantly alleviate the cardiovascular stress reaction caused by tracheal intubation and make hemodynamics stability,it has a more ideal curative effect when using 0.8μg/kg dose,so 0.8μg/kg dose is recommended under close monitoring.