小剂量右美托咪定对高血压患者全身麻醉血流动力学的影响分析

Effect of low-dose dexmedetomidine on hemodynamics in general anesthesia in patients with essential hypertension

目的探讨小剂量右美托咪定对高血压患者全身麻醉血流动力学的影响。方法选取宁波市奉化区人民医院2015年5月~2016年12月收治的92例高血压患者为研究对象,随机均分成观察组和对照组,每组46例。所有患者均采用静吸复合全身麻醉,观察组全麻诱导前10 min持续静脉微泵注射右美托咪定0.3μg/kg（用生理盐水20 mL稀释）;对照组静脉微泵注射生理盐水20 mL。对比2组患者治疗前后平均动脉压（MAP）和心率（HR）,以及患者的手术时间、苏醒时间、拔管时间,RSS镇静评分比较及不良反应发生情况。结果治疗前2组患者的MAP、HR相比较,差异无统计学意义。治疗后2组患者的血清MAP都有所升高,但是观察组治疗后MAP为（109.2±10.2）mmHg明显低于对照组（116.1±11.3）mmHg,治疗后观察组HR为（71.9±3.1）mmHg明显低于对照组（92.1±2.8）mmHg。2组比较差异具有统计学意义（P〈0.05）。2组治疗的手术时间、苏醒时间以及拔管时间相比较,差异无统计学意义。观察组在拔管前（T1）、拔管中（T2）、拔管后1 min（T3）的RSS镇静评分均高于对照组,T1时RSS镇静评分为（2.3±0.4）分明显高于对照组（1.8±0.3）分,T2时RSS镇静评分为（2.9±0.4）分明显高于对照组（2.1±0.3）分,T3时RSS镇静评分为（2.5±0.3）分明显高于对照组（1.9±0.3）分,2组比较差异具有统计学意义（P〈0.05）。2组不良反应相比较,差异无统计学意义。结论小剂量右美托咪定能降低患者的插管、拔管等应激反应,提供了适当的镇静作用,有助于稳定患者的血流动力学指标,保证麻醉效果及手术的正常进行,提高了手术安全性。

Objective To explore the effect of low-dose dexmedetomidine on hemodynamics of general anesthesia in hypertensive patients.Methods A total of 92 patients with hypertension were enrolled from May 2015 to February 2016 in People＇s Hospital of Fenghua District,Ningbo City were randomly divided into observation group and control group,with 46 cases in each group. All patients were treated with static and general anesthesia,the observation group before induction of general anesthesia 10 min received continuous intravenous micro-pump injection of dexmedetomidine 0. 3 μg/kg（ diluted with saline 20 mL）; The control group received intravenous micro-pump injection physiology saline 20 mL. The mean arterial pressure（ MAP）and heart rate（ HR） before and after treatment,and the operation time,recovery time,extubation time,RSS sedation score and adverse reaction occurred were compared between the two groups. Results There was no significant difference in MAP and HR between the two groups before treatment. After treatment,the serum MAP of the two groups was increased,but the MAP in the observation group was（ 109. 2 ± 10. 2） mmHg significantly lower than that in the control group（ 116. 1 ± 11. 3） mmHg,and HR in the observation group was（ 71. 9 ± 3. 1） mmHg significantly lower than that in the control group（ 92. 1 ± 2. 8） mmHg. The difference between the two groups was statistically significant（ P 〈0. 05）. There was no statistically significant difference between the two groups in terms of operation time,recovery time and extubation time. The RSS sedation scores of the observation group before extubation（ T1）,extubation（ T2） and extubation 1 min（ T3） were higher than those of the control group. At T1,the RSS sedation score in the observation group was（ 2. 3 ± 0. 4） points higher than that of the control group（ 1. 8 ± 0. 3） points,At T2,the RSS sedation score was（ 2. 9 ± 0. 4） points higher than that of the control group（ 2. 1 ± 0. 3）,At T3,the RSS sedation score was（ 2. 5 ± 0. 3） points higher than that of the control group（ 1. 9 ± 0. 3）. The difference between the 2 groups was statistically significant（ P 〈0. 05）. There was no significant difference between the two groups in adverse reactions. Conclusion Small doses of dexmedetomidine can reduce the patient＇s pumping,extubation and other stress response,providing the appropriate sedative effect,help to stabilize the patient＇s hemodynamic parameters,to ensure the effect of anesthesia and surgery to improve surgical safety.