右美托咪定联合丙泊酚或依托咪酯对开颅手术老年患者围插管期血流动力学的影响

Effects of dexmedetomidine combined with propofol or etomidate on peri-intubation hemodynamics in elderly patients undergoing craniotomy

目的研究右美托咪定联合丙泊酚或依托咪酯对开颅手术老年患者围插管期血流动力学的影响。方法将80例开颅手术老年患者随机分为生理盐水+丙泊酚(SP)组、生理盐水+依托咪酯(SE)组、右美托咪定+丙泊酚(DP)组、右美托咪定+依托咪酯(DE)组。比较其静脉注药前(T_0)、右美托咪定或生理盐水输注后10 min(T_1)、快诱导(T_2)、插管即刻(T_3)、插管后1 min(T_4)、3 min(T_5)、5 min(T_6)平均动脉压(MAP)、心率(HR)。结果 T_1时DP和DE组患者HR低于SP和SE组;T_2时SP组患者MAP低于其余三组,且DP组患者MAP低于DE组,DP和DE组患者HR低于SE组;T_3时SE组患者MAP高于DP组,且HR高于其余三组;T_4时SE组患者MAP高于其余三组,且SP和SE组患者HR高于DP及DE组患者;T_5时SP和SE组患者MAP和HR高于DP及DE组;T_6时四组患者MAP、HR差异无统计学意义。结论右美托咪定可以稳定择期开颅手术老年患者围插管期的血流动力学,且联合依托咪酯对该类患者血流动力学的影响更小。

Objective To investigate the effects of dexmedetomidine combined with propofol or etomidate on peri-intuhation hemodynamies in elderly patients undergoing eraniotomy. Methods Eighty elderly patients undergoing eraniotomy were randomly divided into 4 groups： saline plus propofol （SP） group, saline plus etomidate （SE） group, dexmedetomidine plus propofol （DP） group, dexmedetonfidine plus etomidate （DE） group. Mean arterial pressure （MAP） and heart rate （HR） at premedieation （To） , 10 min after dexmedetomidine or saline administration （T1）, rapid induetion （T2）, intubation （T3）, 1 Min （T4）, 3 Min （T5） and 5 Min （T6） after intuba- tion were eompared. Results HR of patients in group DP and DE was lower than that in group SP and SE at T1 At T2, MAP was lower in group SP patients than others, and MAP in group DP patients was lower than those in group DE, meanwhile, HR in group DP and DE patients was lower than those in group SE. At T3, MAP was higher in group SE patients than those in group DP, and HR in group DP patients was higher than others. At T4, MAP of patients in group SE showed higher than others, and group HR in SP and SE patients was higher than those in group DP and DE. HR and MAP were higher in patients of group SP and SE than those in group DP and DE at T5. However, no significant differences in MAP and HR were shown among all the groups at T6. Conclusion Dexme- detomidine could stabilize peri-intubation hemodynamies in elderly patients undergoing eraniotomy, and dexmedeto- midine combined with etomidate was a better choice.