右美托咪定对老年高血压患者腹腔镜结肠癌根治术中血流动力学的影响

Effect of dexmedetomidine on hemodynamics of senile patients with hypertension during laparoscopic colorectal cancer radical resection

目的 比较不同剂量右美托咪定对老年高血压患者腹腔镜结肠癌根治手术中血流动力学的影响。方法 选择行腹腔镜结肠癌根治术的老年高血压患者87例。按随机数字表法将分为右美托咪定1组（D1组）、右美托咪定2组（D2组）及生理盐水组（S组）每组29例。D1和D2组静脉泵注右美托咪定0.2、0.4μg/（kg·h）,S组则静脉泵注生理盐水10 ml/h。所有患者均自麻醉诱导前10 min开始持续泵注直至手术完成前30 min停止。比较三组麻醉时间、拔管时间和麻醉恢复室（PACU）停留时间;入手术室时（T0）、插管前1 min（T1）、插管即刻（T2）、插管后1 min（T3）、手术结束时（T4）、拔管后1 min（T5）、离开PACU（T6）时平均动脉压（MAP）、心率（HR）;手术过程中高血压的发生次数;PACU中Ramsay镇静评分、疼痛评分、不良反应发生情况。结果 D1和D2组T2~6MAP、HR以及疼痛评分,发生血压升高及寒战的次数均低于S组（P〈0.05）。D2组拔管时间、PACU停留时间大于S组和D1组。三组Ramsay镇静评分D2组〉D1组〉S组,c差异均有统计学意义（P〈0.05）。结论 右美托咪定0.2及0.4μg/（kg·h）泵注有利于老年高血压患者在腹腔镜结肠癌根治术中血流动力学稳定,镇静效果良好,且麻醉安全性较高。0.2μg/（kg·h）右美托咪定不延迟患者拔管及苏醒时间,更适用于老年高血压患者。

Objective To compare the effect of different doses of dexmedetomidine on hemodynamics during laparoscopic colorectal cancer radical resection in senile patients with hypertension. Methods We selected 87 hypertension patients undergoing laparoscopic colorectal cancer radical resection and randomly divided into 3 groups ： dexmedetomidine injection first group （ group D1 ）, dexmedetomidine injection second group （group D2） and saline control group （group S） ,29 each in each group. The patients in the group D1 and D2 were given the dexmedetomidine 0. 2 and 0. 4 μg/（kg.h） ,respectively. The patients in the group S were injected with salinel0 ml/h. All the patients were injected drugs 10 minutes before anesthesia induction until 30 minutes before the completion of surgery. Duration of anesthesia, extubation time and time in PACU were compared among the three groups. Mean arterial pressure （MAP） and heart rate （HR） at entering into operating room （T0）, 1 minute before endotracheal intubation （T1）, immediately after endotracheal intubation （T2）, 1 minutes after endotracheal intubation （ T3 ）, end of the surgery （T4）, 1 minute before extubation （ T5 ） and leave the PACU （ T6 ） were compared among the three groups. The times of high blood pressure was recorded during surgery. Ramsay score, pain score and postoperative adverse reaction in PACU were also recorded. Results The MAP, HR,pain score,times of elevation blood pressure and shivering at T2 - 6 in the D1 and D2 groups were lower than that in the group S （ P 〈 0. 05 ）. The extubation time and the residence time in PACU in the group were longer than those in the group D1 and group S. Ramsay score in the group D2 was higher than that in the group D1 which was higher than group S （ P 〈 0. 05 ）. Conclusion Intravenous injection of 0. 2 or 0.4 μg/（kg·h） dexmedetomidine can keep the hemodynamic stabilization in senile hypertension patients during laparoscopie eoloreetal cancer radical resection. Furthermore, 0. 2 μg/（ kg· h） dexmedetomidine does not delay the time of extubation and awakening time. Therefore, it is more suitable for the senile patients with hypertension.