右美托咪定对老年高血压合并糖尿病患者的影响

Effect of dexmedetomidine on elderly patients with hypertension complicated with diabetes

目的观察比较不同剂量右美托咪定对老年高血压合并糖尿病患者的影响。方法选择ASAⅡ级高血压合并糖尿病拟行下肢手术患者60例,年龄65～75岁,随机分为3组,每组20例。麻醉平面固定后,于15 min内泵注生理盐水20 m L（C组）、右美托咪定0.5μg/kg（D 0.2组）以及右美托咪定0.5μg/kg（D 0.4组）,然后分别以生理盐水（C组）、右美托咪定0.2μg/（kg·h）（D 0.2组）、右美托咪定0.4μg/（kg·h）（D 0.4组）持续泵入至手术结束。评估各组患者用药前、用药后15 min、用药后30 min、用药后1 h、手术结束时5个时间点患者的心率、平均动脉压、血氧饱和度、镇静评分的变化以及各时点血糖、钾离子的变化。结果与对照组相比,D 0.2组与D 0.4组用药后均有一定程度的镇静作用,血压及心率均下降（P〈0.05）,对于呼吸及钾离子影响小,但短时间内可升高血糖（P〈0.05）。结论右美托咪定对高血压合并糖尿病患者有明显的镇静作用,能够稳定循环,但需要监测血糖变化。

Objective To observe the effect of dexmedetomidine on elderly patients with hypertension complicated with diabetes.Methods Sixty patients,ASA Ⅱ,aged from 65 to 75 years old,who were with hypertension complicated with diabetes and needed operation on lower limbs were randomly divided into three groups（20 cases in each group）.After the block fixed patients were infused intravenously with saline in group C（dexmedetomidine 0.5 μg/kg in group D 0.2 and group D 0.4 within 15 min,and then continued to be given saline in group C,dexmedetomidine0.2 μg/（kg·h） in group D 0.2 and dexmedetomidine 0.4 μg/（kg·h） in group D 0.4 till the end of the operation.The heart rate,MAP,SpO_2,Ramsay score,GLU and K~＋ were evaluated at 5 time points：before drug infusion,15 min after drug infusion,30 min after drug infusion,1 h after drug infusion and at the end of the operation.Results In group D 0.2 and group D 0.4,the sedation effect was good to certain extends,and the blood pressure and heart rate decreased more significantly than that of group C（P〈0.05）.Compared with group C,the medication in group D 0.2 and group D 0.4 had higher GLU（P 〈0.05） in short time but fewer changes of respiration and K~＋.Conclusion Dexmedetomidine is useful for patiens with hypertension complicated with diabetes.It is good for circulation but the GLU should be monitored.