右美托咪定对老年髋关节置换术患者麻醉诱导期血流动力学和脑电双频指数的影响

Effect of Dexmedetomidine on Hemodynamics and Bispectral Index During Anesthesia Induction in Elderly Patients Undergoing Hip Replacement

目的观察右美托咪定对老年髋关节置换术患者麻醉诱导期血流动力学和脑电双频指数的影响,以探讨右美托咪定在老年髋关节置换术中的应用价值。方法选择2019年1月-2020年1月于复旦大学附属金山医院实施的64例老年全髋关节置换术患者为研究对象,采用数字表法分为观察组和对照组,每组32例。麻醉诱导前,观察组患者采取右美托咪定静脉泵注,对照组患者采取等量生理盐水泵注。评估并比较2组患者泵注前(T0)、诱导前(T1)、气管插管前(T2)、插管后即刻(T3)、插管后1 min(T4)、插管后3 min(T5)、插管后5 min(T6)患者的心率、平均动脉压以及BIS值变化情况。结果处理后,与同组T0和T1比较,2组T2、T4、T5、T6时点的MAP均明显下降(P<0.05);与同组T2比较,对照组T3、T4、T5时点MAP明显升高(P<0.05),而观察组各时点差异均无统计学意义(P>0.05);观察组T3、T4时点MAP明显低于对照组(P<0.05),其他时点差异无统计学意义(P>0.05)。与同组T0和T1比较,对照组T2、T5、T6时点的HR明显下降(P<0.05),T3时点HR明显升高(P<0.05);观察组T4、T5、T6时点HR明显下降(P<0.05);与同组T2比较,对照组T3、T4时点HR明显升高(P<0.05),观察组各时点差异无统计学意义(P>0.05);在T3、T4时点,观察组HR明显低于对照组(P<0.05),其他时点HR差异无统计学意义(P>0.05)。与同组T0比较,观察组T1时点BIS明显下降(P<0.05);与同组T0和T1比较,2组T2-T6时点BIS均明显下降(P<0.05);与同组T2比较,对照组T4、T5时点BIS均明显升高(P<0.05),观察组各时点差异无统计学意义(P>0.05);在T1、T4、T5时点,观察组BIS值明显低于对照组(P<0.05)。结论右美托咪定在老年髋关节置换术患者的麻醉诱导前使用,能发挥显著镇静作用,抑制气管插管后的应激反应,进而维持血流动力学稳定。

Objective To observe the effect of dexmedetomidine(Dex)on hemodynamic and bispectral index(BIS)during anesthesia induction in elderly patients undergoing hip replacement and to explore the application value of dexmedetomidine in hip replacement in the elderly.Methods A total of 64 elderly patients who underwent total hip replacement in our hospital from January 2019 to January 2020 were selected as the subjects.They were randomly divided into observation group and control group,32 ones in each group.Before anesthesia induction,patients in the observation group were injected with dextromethomidine,while those in the control group were injected with the same amount of normal saline.The changes of heart rate,mean arterial pressure(MAP)and BIS were recorded and compared between the two groups before pumping(T0),before induction(T1),before tracheal intubation(T2),immediately after intubation(T3),1 minute after intubation(T4),3 minutes after intubation(T5)and 5 minutes after intubation(T6).Results Compared with T0 and T1,MAP at T2,T4,T5,and T6 of both groups decreased significantly(P<0.05);Compared with T2,the MAP at T3,T4,and T5 of the control group increased significantly(P<0.05),but there was no statistical difference at each time point in the observation group(P>0.05);The MAP of the observation group at T3 and T4 was significantly lower than that of the control group(P<0.05),there was no statistically significant difference at other time points(P>0.05).Compared with T0 and T1,HR at the T2,T5,and T6 of the control group decreased significantly(P<0.05),and HR at the T3 increased significantly(P<0.05);HR at the T4,T5,and T6 of the observation group decreased significantly.(P<0.05);Compared with T2,HR of the control group increased significantly at T3 and T4(P<0.05),and there was no statistical difference at each time point in the observation group(P>0.05);At T3 and T4,HR of the group was significantly lower than that of the control group(P<0.05),and there was no statistical difference at other time points(P>0.05).Compared with T0,the BIS of the observation group at T1 decreased significantly(P<0.05);compared with T0 and T1,the BIS of both groups at T2-T6 decreased significantly(P<0.05);compared with T2,BIS of the control group at T4,T5 increased significantly(P<0.05),and there was no statistical difference at each time point in the observation group(P>0.05);At T1,T4,and T5,BIS of the observation group was significantly lower than that of the control group(P<0.05).Conclusion Dexmedetomidine,used before anesthesia induction in elderly patients undergoing hip replacement,can play a significant role in sedation,inhibit stress response induced by tracheal intubation,and maintain hemodynamic stability.