右美托咪定与丙泊酚在老年人经尿道前列腺手术中的应用

Application of Dexmedetomidine versus Propofol in elderly patient undergoing transurethral resection of the prostate

目的探讨右美托咪定在老年人经尿道前列腺手术中辅助镇静的有效性和安全性。方法选取60例择期行经尿道前列腺手术的老年患者,随机均分为右美托咪定组30例和丙泊酚组30例,在腰麻平面确定后,泵注右美托咪定(负荷量0.5 μg/kg 10 min,继以0.2~0.4 μg·kg^-1·h^-1持续泵注)或丙泊酚(初始血浆靶浓度为0.5 mg/L,待与效应室浓度平衡后以0.1 mg/L的幅度递增),记录起效时间[改良镇静/警觉评分(OAA/S)≤3分]和给药后特定时间点血压、心率、呼吸频率、脉搏氧饱和度、呼气末二氧化碳分压、脑电双频谱指数(BIS)值、OAA/S评分,记录不良事件的发生率和镇静满意度评分。结果给药后20 min OAA/S评分丙泊酚组(3.0±0.5)分明显比右美托咪定组(3.5±0.6)分低(t=2.300,P=0.030);丙泊酚组在给药后30 min和40 min的收缩压分别为(107.6±11.2)mmHg(1 mmHg=0.133 kPa)、(106.7±9.6)mmHg,较右美托咪定组(119.2±16.4)mmHg、(121.2±18.3)mmHg明显降低(t=2.151、2.555,P=0.041、0.017);丙泊酚组给药后10 min的舒张压(69.8±6.7)mmHg比右美托咪定组(78.0±10.1)mmHg明显降低(t=2.462,P=0.021)。右美托咪定组心动过缓的发生率为20.0%(6/30),丙泊酚组无1例发生心动过缓(χ^2=6.667,P=0.010);而丙泊酚组呼吸抑制的发生率为13.3%(4/30)、不自主运动的发生率为30.0%(9/30),而右美托咪定组无1例发生呼吸抑制和出现不自主运动(χ^2=4.286、10.588,P=0.038、0.001)。结论与传统的丙泊酚比较,右美托咪定单独应用于老年患者腰麻下经尿道前列腺手术的辅助镇静效果确切,患者安静合作,无呼吸抑制,血压更平稳,但心动过缓发生率较高。

Objective To investigate the efficiency and safety of Dexmedetomidine as adjuvant to local anesthetics in elderly patient undergoing transurethral resection of the prostate. Methods Sixty elderly patients undergoing selective transurethral resection of the prostate were randomly divided into the Dexmedetomidine group and the Propofol group(n=30, each). After block level of spinal anesthesia was determined, Dexmedetomidine(a bolus dose of 0.5 μg/kg for 10 minutes, then continuous injection of 0.2-0.4 μg·kg^-1·h^-1)or Propofol(initial plasma concentration of 0.5 mg/L, after getting equal to an effect compartment drug concentration, plasma concentration was gradually increased by 0.1 mg/L)was injected with an infusion pump.Observation items were recorded, including the onset time[observer's assessment of alertness/sedation(OAA/S)≤3 points], blood pressure, heart rate, respiratory rate, pulse oxygen saturation, end-tidal carbon dioxide partial pressure, bispectral index value(BIS), and OAA/S score as well as adverse events and patients' satisfaction to sedation. Results The OAA/S score after 20 minutes of drug injection was lower in the Propofol group than in the Dexmedetomidine group(3.0±0.5 scores vs.3.5±0.6 scores, t=2.300, P=0.030). The systolic pressure levels were lower in the Propofol group than in the Dexmedetomidine group after 30 minutes and 40 minutes of drug injection(107.6±11.2 mmHg vs.119.2±16.4 mmHg, 106.7±9.6 mmHg vs.121.2±18.3 mmHg, 1 mmHg=0.133 kPa, t=2.151 and 2.555, P=0.041 and 0.017). The diastolic pressure was lower in the Propofol group than in the Dexmedetomidine group after 10 minutes of drug injection(69.8±6.7 mmHg vs.78.0±10.1 mmHg, t=2.462, P=0.021). The incidence of bradycardia was higher in the Dexmedetomidine group than in the Propofol group(20.0% or 6/30 vs.0.0% or 0/30,χ^2=6.667, P=0.010). The incidences of respiratory depression and involuntary movement were lower in the Dexmedetomidine group than in the Propofol group(0.0% or 0/30 vs.13.3% or 4/30, 0.0% or 0/30 vs.30.0% or 9/30,χ^2=4.286 and 10.588, P=0.038 and 0.001). Conclusions Compared with the conventional Propofol, Dexmedetomidine has a definite sedative effect in elderly patients undergoing transurethral resection of the prostate under spinal anesthesia, with peace and cooperation, greater stability of blood pressure, without breath depression, but with higher incidence of bradycardia.