右美托咪啶对静吸复合全麻老年患者苏醒期的影响

Effect of Dexmedetomidine on Clinical Profiles in elderly Patients during Recovery of General Anesthesia

目的研究预先静注小剂量右美托嘧啶(Dexmedetomidine,DEX)对老年人静吸复合全麻手术苏醒期的影响。方法选择60例静吸复合全麻下行腹部手术老年患者,年龄65-81岁,随机分为DEX组和对照组,每组30例。两组术中均行静吸复合全麻,DEX组患者于手术结束前10min内静脉泵注DEX 0.5μg/kg,对照组患者静脉泵注相同容量生理盐水。观察并记录注射时(T_1)、注射后10min(T_2)、拔管时(T_3)、拔管后10min(T_4)的收缩压(SBP)、舒张压(DBP)、心率(HR)、脉搏血氧饱和度(SpO_2),停止吸入七氟醚至拔除气管导管的时间以及Ramsay评分、躁动评分、耐管评分。结果 DEX组的SBP、DBP、HR在T2、T3、T4观察时间点较T1相比无统计学差异(P>0.05)。而对照组T2、T3、T4观察时间点的SBP、DBP、HR比T1明显升高(P<0.05)。DEX组患者在T2、T3、T4观察时间点的SBP、DBP、HR都低于对照组(P<0.05)。两组各个观察时间点的SpO_2组间及组内比较均无统计学差异(P>0.05)。DEX组的Ramsay评分、躁动评分、耐管评优率结果均优于对照组(P<0.05)。结论老年人全麻苏醒拔管期静注小剂量DEX可明显减少全麻后躁动及麻醉苏醒期间的血流动力学变化,而且无呼吸抑制作用。

Objective To determine the effect of dexmedetomidine（DEX）by the end of operation on clinical profiles during recovery of general anesthesia of elderly patients.Methods 60 elderly patients aged 65 to 81 years old who were undergoing abdominal surgery were randomly divided into DEX group or control group.Patients in DEX group were administered DEX at a dose of 0.5μg/kg over 10 min and patients in control group were given a placebo infusion of normal saline by the end of the operation.Systolic blood pressure（SBP）,diastolic blood pressure（DBP）,heart rate（HR）,pulse oxygen saturation（SpO2）,extubation time and Ramsay score,Agitation score and Tube score were recorded before injection（T1）,10 min after injection（T2）,extubation（T3）,10 min after extubation（T4）.Results There were no significantly differentiation of SBP,DBP,HR between DEX group and control group at T1,T2,T3 and T4 observation time points（P〉0.05）.SBP,DBP,HR in control group were significantly increased at T2,T3 and T4（P〈0.05）.In group DEX,SBP,DBP and HR at T2,T3 and T4 observation time were lower than those in control group（P〈0.05）.There was no significant difference of the SpO2 between the two groups in the observation time points（P〉0.05）.The Ramsay score,agitation score,and tube resistance rate in group DEX were better than those in control group（P〈0.05）.Conclusion The intravenous injection of small dose of DEX during the extubation and extubation of general anesthesia in the elderly can significantly reduce the agitation after anesthesia and the hemodynamic changes during the wake of anaesthesia,and there is no respiratory inhibition.