右美托咪定对老年骨折手术患者全身麻醉苏醒期躁动的影响

Effect of dexmedetomidine on agitation during general anesthesia recovery period in elderly patients underwent orthopedic surgery

目的观察右美托咪定对老年骨折手术患者全身麻醉苏醒期躁动的预防作用。方法选取2014年1月至2016年1月宜宾市第二人民医院收治的老年骨折患者90例,所有患者在七氟烷全身麻醉下进行骨折手术,其中45例患者术中持续静脉滴注右美托咪定(右美托咪定组),45例患者术中持续静脉滴注生理盐水(对照组)。比较2组患者手术结束后自主呼吸恢复时间、睁眼时间以及拔除喉罩时间,观察2组患者使用前右美托咪定前(T_0)、拔除喉罩时(T_1)及拔除喉罩后10 min(T_2)、20 min(T_3)、40 min(T_4)时血压、心率、脉搏血氧饱和度(SpO_2)变化,并进行躁动评分;观察2组患者术后并发症情况。结果右美托咪定组患者术后自主呼吸恢复时间、睁眼时间及拔除喉罩时间分别为(6.83±2.13)、(8.12±2.11)、(9.32±2.01)min,对照组患者术后自主呼吸恢复时间、睁眼时间及拔除喉罩时间分别为(6.23±1.85)、(8.91±2.32)、(9.45±2.91)min,2组比较差异均无统计学意义(P>0.05)。T_0、T_1时2组患者心率、收缩压、舒张压及SpO_2比较差异均无统计学意义(P>0.05);2组患者T_2、T_3、T_4时心率、收缩压、舒张压及SpO_2与T_0、T_1时比较差异均无统计学意义(P>0.05);T_2、T_3、T_4时,右美托咪定组患者心率、收缩压和舒张压显著低于对照组(P<0.05),但2组患者SpO_2比较差异无统计学意义(P>0.05)。对照组患者低氧血症、寒战和导管脱出发生率分别为8.89%(4/45)、42.22%(19/45)和11.11%(5/45),右美托咪定组患者低氧血症、寒战和导管脱出发生率分别为11.11%(5/45)、6.67%(3/45)和0.00%(0/45),右美托咪定组患者寒战、导管脱出发生率显著低于对照组(P<0.05),但2组患者低氧血症发生率比较差异无统计学意义(P>0.05)。结论老年骨折患者术中持续静脉应用右美托咪定,能够有效降低患者麻醉苏醒期躁动的发生率,维持血流动力学稳定,减少术后并发症。

Objective To observe the preventive effect of dexmedetomidine on agitation during general anesthesia recovery period in elderly patients underwent orthopedic surgery. Methods Ninety elderly patients with fracture were selected from January 2014 to January 2016 in the Second People＇s Hospital of Yibin City. All patients underwent surgery under general anesthesia with sevoflurane. Forty-five patients in dexmedetomidine group received continuous intravenous infusion of dexmedetomidine during operation,the other 45 patients in control group received continuous intravenous infusion of saline. The spontaneously breathing recovery time,opening eye time and laryngeal mask extraction time after operation were compared between the two groups. The changes in blood pressure,heart rate and pulse oxygen saturation（ SpO2） were observed at the time points of before using dexmedetomidine（ T0）,laryngeal mask extraction（ T1）,10 min after extraction（ T2）,20 min after extraction（ T3） and40 min after extraction（ T4）. The agitation score was performed at the same time. The postoperative complications were observed in the two groups. Results The postoperative spontaneously breathing recovery time,opening eye time and laryngeal mask extraction time in dexmedetomidine group were（ 6. 83 ± 2. 13）,（ 8. 12 ± 2. 11） and（ 9. 32 ± 2. 01） min respectively; and them in control group were（ 6. 23 ± 1. 85）,（ 8. 91 ± 2. 32） and（ 9. 45 ± 2. 91） min respectively; there was no significant difference in them between the two groups（ P〉0. 05）. There was no significant difference in the heart rate,systolic blood pressure,diastolic blood pressure and SpO2 between the two groups at the time points of T0 and T1（ P〉0. 05）. There was no significant difference in the heart rate,systolic blood pressure,diastolic blood pressure and SpO2 between the time points of T2,T3,T4 and T0,T1 in the two groups（ P〉0. 05）. The heart rate,systolic blood pressure and diastolic blood pressure in dexmedetomidine group were significantly lower than those in control group at the time points of T2,T3 and T4（ P〈0. 05）; but there was no significant difference in the SpO2 between the two groups（ P〈0. 05）. The incidence of hypoxemia,chills and catheter prolapse were 8. 89%（ 4/45）,42. 22%（ 19/45） and 11. 11%（ 5/45） in control group; and them in dexmedetomidine group were 11. 11%（ 5/45）,6. 67%（ 3/45） and0. 00%（ 0/45） respectively; the incidence of chills and catheter prolapse in dexmedetomidine group were significantly lower than those in control group（ P〈0. 05）; but there was no significant difference in the incidence of hypoxemia between the two groups（ P〈0. 05）. Conclusion Dexmedetomidine can effectively reduce the incidence of agitation during general anesthesia recovery period,maintain hemodynamic stability and reduce postoperative complications in the elderly patients with fracture.