右美托咪定复合舒芬太尼静脉麻醉在老年患者眼科手术中的应用

Application of dexmedetomidine combined with sufentanil intravenous anesthesia in ophthalmic surgery of elderly patients

目的观察不同剂量的右美托咪定(DEX)、舒芬太尼(SF)对眼科手术中老年患者循环、呼吸系统的影响。方法选择2016年5月~2017年3月40例表面麻醉下行双眼白内障术的老年患者,年龄60~70岁,ASAⅡ级,双眼手术隔日分次施行,采用自身配对设计方法,手术眼别采用数字表法随机选择,首次手术为A组(DEX 4μg+SF1μg),隔日手术为B组(DEX 8μg+SF 2μg)。观察记录入室后5 min(T1)、表面麻醉时(T2)、手术开始后10 min(T3)、术后20 min(T4)的平均动脉血压(MAP)、心率(HR)、脉搏血氧饱和度(SpO_2)、呼吸频率(RR)、呼气末二氧化碳分压(PEtCO_2)、改良Ramsay镇静评分(MSSR)。结果两组患者T1时点的MAP、HR比较差异无统计学意义(P>0.05);A组患者T2、T3、T4时点的MAP、HR与T1时点比较差异无统计学意义(P>0.05);B组患者T2、T3、T4时点的MAP、HR明显低于A组同时点(P<0.01)。两组患者各时点的SpO_2、RR、PEtCO_2、MSSR比较差异无统计学意义(P>0.05)。结论单次静脉注射不同小剂量的DEX+SF对老年患者的呼吸系统均无不良影响,且产生的镇静效应相似,而静脉注射不同小剂量的DEX+SF会抑制老年患者循环系统,导致血压、心率下降,影响程度与注射剂量呈正相关,静脉注射DEX 8μg+SF 2μg的剂量能产生10%左右的抑制心血管效应。

Objective To observe the effects of different doses of dexmedetomidine（DEX） and sufentanil（SF） on circulation and respiration in elderly patients during ophthalmic surgery. Methods 40 elderly patients undergoing bilateral cataract surgery under surface anesthesia, who were aged from 60 to 70 years old, with ASA grade Ⅱ from May 2016 to March 2017 were selected. Binocular surgery was performed on every other day. Self-matching design method was used. And surgical eyes were randomly selected using the digital table method. The patients with the first surgery were as group A（DEX 4μg＋SF 1 μg）, and the patients with every other day surgery were as group B（DEX 8 μg＋SF 2μg）. The mean arterial blood pressure（MAP）, heart rate（HR）, SpO2, respiratory rate（RR）, end-tidal carbon dioxide（PEtCO2）, modified Ramsay sedation score（MSSR） at 5 min after entering the room（T1）, the time of surface anesthesia（T2）, 10 min after operation（T3） and 20 rain after surgery（T4） were observed and recorded. Results There were no significant differ- ences in MAP and HR between the two groups at TI（P〉0.05）. There was no significant difference in MAP, HR between T2, T3 and T4 compared with T1 in the group A（P〉0.05）. The MAP and HR in group B were significantly lower than those in group A at T2, T3 and T4（P〈0.01）. There were no significant differences in SpO2, RR, PEtCO2 and MSSR between the two groups at each time point（P〉0.05）. Conclusion A single intravenous injection of different doses of DEX＋ SF has no adverse effect on the respiratory system in elderly patients and produces similar sedation effects. However, intravenous injection of different doses of DEX＋SF can inhibit circulatory system in elderly patients, resulting in the decrease of blood pressure and heart rate. The degree of influence is positively related to injection dose. Intravenous injection of DEX 8μg＋SF 2μg can produce about 10% of cardiovascular inhibition effeets.