α_2受体激动剂用于老年患者全身麻醉诱导的研究

α_2 Receptor Agonists Used for Induction of General Anesthesia in Elderly Patients

目的:观察α_2受体激动剂盐酸右美托咪定对老年患者全麻诱导的有效性和临床价值。方法:选取2013年3月-2016年12月择期手术老年患者96例,采用随机数字表法分成三组,每组32例。A组为对照组,入室建立监护,依次静脉注射咪达唑仑0.05 mg/kg、舒芬太尼0.2μ g/kg、依托咪酯0.2 mg/kg和顺式阿曲库铵0.2 mg/kg行全麻诱导气管插管。B组患者在麻醉诱导前10 min微量泵输注2μ g/kg盐酸右美托咪定,其余用药同A组。C组患者在麻醉诱导前10 min微量泵输注1μ g/kg右美托咪定,其余用药同B组。三组患者分别于麻醉诱导前(T_0)、气管插管前即刻(T_1)、插管后1 min(T_2)、插管后5 min(T_3)、插管后10 min(T_4)和插管后15 min(T_5)记录MAP和HR,同时观察诱导过程中患者有无呛咳、流泪、体动等不良反应。结果:诱导前(T_0),B组和C组的MAP和HR均低于A组,差异均有统计学意义(P<0.05),A组患者在T_1和T_2时间段MAP和HR均不同程度升高,较之B组和C组,差异均有统计学意义(P<0.05)。但在T_3、T_4和T_5时间段,三组患者MAP和HR比较,差异均无统计学意义(P>0.05)。其中B组和C组HR在诱导前均降低,尤其B组更甚,差异有统计学意义(P<0.05)。结论:盐酸右美托咪定可用于老年患者的麻醉诱导,其中1μ g/kg的剂量对患者的血压和心率影响更小,可提供更为稳定的血流动力学,值得临床推广。

Objective： To investigate the efficacy and clinical value of a 2 receptor agonist Dexmedetomidine in the induction of general anesthesia in elderly patients.Method： From March 2013 to December 2016, 96 cases of elderly patients undergoing elective surgery were divided into three groups according to the random number table method, 32 eases in each group.Group A was the control group, established monitor when into operation room, intravenous injected Midazolam 0.05 mg/kg, Sufentanil 0.2 μg/kg, Etomidate 0.2 mg/kg and Cisatracurium 0.2 mg/kg sequentially, then take tracheal intubation under general anesthesia.The patients in group B were given 2 p. g/kg Dexmedetomidine by micropump infusion before anesthesia induction 10 min, and rest of the drugs were the same as the A group.Patients in group C were given 1 p~ g/kg Dexmedetomidine before anesthesia induction by micropump infusion before anesthesia induction 10 rain, and the rest were treated the same as group B. The MAP and HR of three groups were recorded at anesthesia induction （ To ）, immediately before intubation （ T1 ）,1 rain after intubation （ T2 ）, 5 min after intubation （ T3 ）, 10 min after intubation （ T4 ） and 15 min after intubation （Ts） respectively, observed if there was cough, tears, body movement and other adverse reactions during induction.Result： Beforeinduction （ To ）, the MAP and HR if group B and group C were lower than those of group A, the differences were statistically significant （ P〈0.05 ）, the MAP and HR of group A were increased in different degrees at TI and T2, compared with group B and group C, the differences were statistically significant （ P〈0.05 ）, but at the T3, T4 and Ts, there was no significant differences in MAP and HR between the 3 groups （ P〉0.05 ）, HR of group B and group C was decreased before induction, especially in group B, the difference was statistically significant （P〈0.05） .Conclusion： Dexmedetomidine Hydrochloride can be used for anesthesia induction in elderly patients, in which the dosage of 1 μ g/kg has less influence on blood pressure and heart rate, can provides more stable hemodynamics, worthy of clinical promote.