不同剂量右美托咪定复合喷他佐辛对老年换膝术苏醒期的影响

Impact of different doses of dexmedetomidine combined with pentazocine on the elderly patient′s recovery after TSK

目的分析不同剂量右美托咪定复合喷他佐辛对老年换膝术苏醒期的影响。方法选择2014年1月至2016年5月于我院行择期行人工单膝置换术的120例的老年患者作为研究对象,年龄60~75岁。将患者按随机数字表法分为4组,分别为喷他佐辛组(P组,30例),小剂量右美托咪定+喷他佐辛组(D1+P组,30例),中剂量右美托咪定+喷他佐辛组(D2+P组,30例),大剂量右美托咪定+喷他佐辛组(D3+P组,30例)。监测手术期间血流动力学变化情况,记录比较手术结束时(T_1)、拔管后即刻(T_2)、拔除气管导管后5min(T_3)时的各组的平均动脉压(MAP)和心率(HR)、苏醒时间及拔管时间及不良反应发生情况。结果 P组苏醒期不同时间点MAP与HR差异有统计学意义(P<0.05);D1+P组、D2+P组、D3+P组苏醒期MAP与HR不同时刻间比较差异无统计学意义(P>0.05);4组苏醒时间与拔管时间比较,P组与D1+P组间差异无统计学意义(P>0.05),D3+P组苏醒时间与拔管时间显著高于其他3组,差异有统计学意义(P<0.05),而D2+P组拔管时间和苏醒时间显著低于P组、D1+P组(P<0.05);D1+P组、D2+P组不良反应发生率差异无统计学意义(P>0.05),P组躁动、恶心呕吐发生率显著高于其他3组(P<0.05),D3+P组心动过缓发生率明显高于D1+P组、D2+P组(P<0.05)。结论在老年换膝术中,应用中等剂量的右美托咪定能有效维持全麻苏醒期的血流动力学稳定性,缩短拔管时间,减少不良反应的发生,可作为首选麻醉方案在临床加以推广应用。

Objective To study the impact of different doses of dexmedetomidine combined with pentazoeine on the elderly patient＇s recovery after TSK. Methods One hundred and twenty patients aged 60 to 75 years, who were adopting TSK from January 2014 to May 2016 in our hospital, were selected. The subjects were divided into control group （30 cases）, low-dose group （30 cases）, middle-dose group （30 cases） and high-dose group （30 ca- ses） according to the different doses of dexmedetomidine. During the intubation process, the hemodynamic change was monitored. MAP, HR, recovery time and adverse reactions after surgery （T1）, after intubation （T2） and after 5min of intubation （T3） for each group were compared. Results At different time points, MAP and HR for control group was significantly different （P〈0. 05） ; at different time points, MAP and HR for low-dose group and high-dose group was not significantly different （P〈0.05） ; the recovery time and intubation time for control group and low-dose group was not significantly different （P〈0.05）; the recovery time and intubation time for high-dose group was longer than those of the other two groups （P〈0.05） ; the adverse event rate of low-dose group and high-dose group was not significantly different （P〈0.05） ; the adverse events such as nausea and vomi- ting and the trembling event rate of control group was higher than that of the other three groups （P〈0.05）. The incidence rate of bradycardia in high dose group was higher than that of the other groups（P〈0. 05）. Conclusion During TSK, the moderate dose of dexmedetomidine can maintain the hemodynamics stability in the recovery peri- od of general anesthesia, shorten the intubation time and reduce the adverse event rate. The anesthesia method is worthy of clinical promotion and application.