不同剂量右美托咪定对老年腹腔镜胆囊切除术病人围术期血流动力学及心功能的影响

Effects of different doses of dexmedetomidine on perioperative hemodynamics and cardiac function in elderly patients with laparoscopic cholecystectomy

目的探讨不同剂量右美托咪定对老年腹腔镜胆囊切除术病人围术期血流动力学及心功能的影响。方法选取我院2016年1月至2017年3月收治的老年行腹腔镜胆囊切除术病人120例,美国麻醉协会(ASA)分级为Ⅰ级或Ⅱ级,根据随机数字表法分为3组,每组40例。A组和B组分别于麻醉诱导开始时泵注10 ml0.3μg/kg和0.6μg/kg的右美托咪定,C组泵注10 ml的生理盐水。比较3组病人麻醉诱导时(T0)、建立气腹后10 min(T1)、术毕(T2)、拔管时(T3)和拔管后10 min(T4)时刻的平均动脉压(MAP)、心率(HR)、心排量(CO)、每搏输出量(SV)和心指数(CI),并比较3组病人T0、T1、T2时刻的Ramsay镇静评分。结果 A组和B组T1、T2时刻的Ramsay镇静评分均明显高于C组(P<0.05),B组T2、T3时刻的Ramsay镇静评分明显高于A组(P<0.05);B组T1、T2、T3、T4时刻的MAP、HR均明显低于A组和C组(P<0.05);3组病人T1、T2、T3、T4时刻的CO、SV、CI比较差异均无统计学意义(P>0.05)。结论 0.6μg/kg右美托咪定可有效维持老年腹腔镜胆囊切除术病人围术期血流动力学稳定,提高了术中镇静效果,且对病人心功能无明显影响。

Objective To investigate the effects of different doses of dexmedetomidine on perioperative hemodynamics and cardiac function in elderly patients with laparoscopic cholecystectomy.Methods A total of 120 cases of elderly patients received laparoscopic cholecystectomy from January2016 to March 2017 in our hospital were selected,and were randomly divided into three groups,with 40 cases in each group.Group A,B received an intravenous infusion of 0. 3 or 0. 6 μg/kg dexmedetomidine hydrochloride,while group C was injected 10 ml saline. The mean arterial pressure（ MAP）,heart rate（ HR）,cardiac output（ CO）,stroke volume（ SV） and cardiac index（ CI） were observed and compared among the three groups at anesthesia induction（ T0）,10 min after insufflation（ T1）,at the end of surgery（ T2）,extubation time（ T3） and 5 min after extubation（ T4）.The Ramsay sedation scores in three groups were evaluated and compared at T0,T1,T2. Results The scores of Ramsay sedation in group A and group B were significantly higher than those in group C at T1,T2（ P〈0. 05）,and the significant difference was also found between group B and group A（ P〈0. 05）. The levels of MAP,HR in group B were significantly lower than those in group A and group C at T1-T4（ P〈0. 05）; There were no significant differences in CO,SV and CI between three groups at T1-T4（ P〉0. 05）. Conclusions Dexmedetomidine（ 0. 6 μg/kg） can effectively maintain the perioperative hemodynamic stability in elderly patients undergoing laparoscopic cholecystectomy,improve the effect of sedation during operation with few effect on the cardiac function.