盐酸右美托咪定注射液对老年胸外科手术患者麻醉苏醒期的影响

Effects of Dexmedetomidine Hydrochloride Injection on Elderly Patients Underwent Thoracic Surgery during Anesthesia Recovery Period

目的:探讨盐酸右美托咪定注射液对老年胸外科手术患者麻醉苏醒期的影响。方法:将2014年6月-2016年2月在我院接受胸外科手术的老年患者60例作为研究对象,按入院单双号分为对照组和观察组,各30例。对照组患者在面罩吸氧5 min后静脉注射丙泊酚注射液0.5~1 mg/kg,观察组患者静脉注射盐酸右美托咪定注射液0.5~1.0μg/kg,然后两组患者均依次静脉注射依托咪酯乳状注射液0.1~0.2 mg/kg、枸橼酸舒芬太尼注射液0.3μg/kg、注射用苯磺顺阿曲库铵0.2 mg/kg进行麻醉诱导。麻醉诱导后进行气管插管,并采用呼吸机进行辅助通气,之后对照组患者持续静脉滴注丙泊酚注射液3~6 mg/(kg·h),观察组患者持续静脉滴注盐酸右美托咪定注射液0.2~0.5μg/(kg·h),同时两组患者持续静脉滴注枸橼酸舒芬太尼注射液0.1~0.2μg/(kg·min)、注射用苯磺顺式阿曲库铵1.5~2μg/(kg·min),持续吸入1%~2%七氟醚进行维持麻醉。观察两组患者术前(T_0)、麻醉诱导后(T_1)、吸痰拔管时(T_2)、拔管后5 min(T_3)、拔管后30 min(T_4)时的血流动力学指标[心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_2)]及术后苏醒情况,以及躁动、谵妄、咳嗽与不自主运动发生情况。结果:T_2、T_3时,对照组患者HR、MAP较T_0、T_1时显著升高,且高于观察组,差异均有统计学意义(P<0.05);T_0、T_1、T_4时,两组患者HR、MAP水平比较,差异均无统计学意义(P>0.05);T_0、T_1、T_2、T_3、T_4,两组患者SpO_2水平比较,差异均无统计学意义(P>0.05)。观察组患者呼吸恢复、呼之睁眼、拔管时间均显著短于对照组,差异均有统计学意义(P<0.05)。观察组患者术后躁动、谵妄、咳嗽及不自主运动的发生率显著低于对照组,差异均有统计学意义(P<0.05)。结论:盐酸右美托咪定注射液能够维持老年胸外科手术患者麻醉苏醒期血流动力学稳定,缩短苏醒时间,减少术后躁动、谵妄、咳嗽及不自主运动等应激反应的发生。

OBJECTIVE:To investigate the effects of Dexmedetomidine hydrochloride injection on elderly patients underwent thoracic surgery during anesthesia recovery period.METHODS:Totally60elderly patients underwent thoracic surgery in our hospital during Jun.2014-Feb.2016were selected as research objects and then divided into control group and observation group accordingto even and odd-numbered admission order,with30cases in each group.Control group was given Propofol injection0.5-1mg/kg intravenously5min after mask oxygen inhalation.Observation group was given Dexmedetomidine hydrochloride injection0.5-1.0μg/kg intravenously.Both group were successively given Etomidate emulsion injection0.1-0.2mg/kg,Sufentanil citrate injection0.3μg/kg and Cisatracurium besilate for injection0.2mg/kg intravenously for anesthesia induction;tracheal intubation was performed and ventilator was used to assist ventilation after anesthesia induction.And then control group was given continuous intravenous dripping of propofol3-6mg/kg·h;observation group was given continuous intravenous dripping of Dexmedetomidine hydrochloride injection0.2-0.5μg/(kg·h).At the same time,both group were given continuous intravenous dripping of sufentanil0.1-0.2μg/(kg·min)and cis-atracurium1.5-2μg/(kg·min),and continuously inhaled1%-2%sevoflurane for anesthesia maintenance.Hemodynamic index(HR,MAP,SpO2),postoperative recovery,the occurrence of delirium,restlessness,cough and involuntary movement were observed in2groups before surgery(T0),after anesthesia induction(T1),at the moment of sputum suction and extubation(T2),5min after extubation(T3),30min after extubation(T4).RESULTS:At T2and T3,HR and MAP of control group were increased significantly compared to at T0,T1,and higher than those of observation group,with statistical significance(P<0.05).At T0,T1,T4,there was no statistical significance in HR and MAP between2groups(P>0.05).At T0,T1,T2,T3,T4,there was no statistical significance in SpO2level between2groups(P>0.05).The breathing recovery time,eye openning time and extubation time of observation group were significantly shorter than those of control group,with statistical significance(P<0.05).The incidence of postoperative restlessness,delirium,cough and involuntary movement in observation group were significantly lower than control group,with statistical significance(P<0.05).CONCLUSIONS:Dexmedetomidine hydrochloride injection can keep hemodynamics stable in elderly patients underwent thoracic surgery during anesthesia recovery period.,shorten recovery time and reduce the occurrence of stress response as postoperative delirium,restlessness,cough,involuntary movement.