小剂量右美托咪定持续输注对老年患者椎体后凸球囊扩张成形术中呼吸与循环的影响

Effect of continuous infusion of small dose dexmedetomidine on respiratory and circulatory function in elderly patients undergoing percutaneous kyphoplasty

目的:探讨右美托咪定辅助镇静麻醉对老年患者俯卧位腰椎后凸成形术(PKP)中循环和呼吸功能的影响。方法:24例老年PKP手术患者,年龄<70岁者给予右美托咪定40μg的负荷量,年龄≥70岁的给予30μg的负荷量,均在30 min内微泵注射完毕。右美托咪定泵注15 min后开始手术。采集入室后(t0)、右美托咪定泵注10 min(t1),20 min(t2),30 min(t3)以及术前(ta)、术中(tb)和术毕(tc)患者平均动脉压(MAP)和心率(HR);记录术中最低血压和最慢心率发生时间;记录术中最高Ramsay镇静评分;在t0,ta和tc采集右侧锁骨下静脉血液进行血气分析。结果:所有患者术中Ramsay镇静评分满意,患者MAP和HR持续下降,最低血压和最慢心率均出现在右美托咪定持续泵注的25~45 min,术中最低血压下降幅度及最慢心率都在安全范围之内;右美托咪定泵注后改善氧合,指脉搏氧饱和度(SpO 2)和锁骨下静脉血氧分压(PvO 2)持续升高,差异有统计学意义(P<0.05),术中PvO2与锁骨下静脉血氧饱和度(SvO2)维持平稳,锁骨下静脉血二氧化碳分压(PvCO2)、乳酸(Ralv)、血糖(GLUv)升高;与t 0比较,t c时PvCO 2升高,差异有统计学意义(P<0.05)。结论:小剂量持续泵注右美托咪定能维持老年患者PKP术中氧供/氧耗平衡,减少循环波动及心血管意外发生;合并慢性阻碍性通气功能障碍(COPD)的患者存在二氧化碳蓄积的风险。

Objective:To explore the effect of dexmedetomidine on circulatory and respiratory function in elderly patients undergoing Percutaneous Kyphoplasty(PKP).Methods:A total of 24 patients undergoing PKP were selected as the subjects.Continuous infusion of dexmedetomidine within 30 minutes,The loading doses of 40μg or 30μg were given to the elderly under 70 or over 70 respectively.The operation begins 15 minutes after infusion of dexmedetomidine.Clinical characters were recorded including mean arterial pressure(MAP),heart rate(HR)after entering the operation room(t0),10 minutes after infusion of dexmedetomidine(t1),20 minutes after infusion(t2),30 minutes after infusion(t 3),and preoperative(t a),intraoperative(t b),and postoperative(tc).The moment of lowest blood pressure and slowest heart rate was recorded.The highest sedation score was recorded during the operation.Subclavian venous blood gas was collected at t0,ta,tc.Results:Ramsay sedation score of all patients were perfect intraoperative;MAP,HR of all patients were significantly reduced,and these were in the safe area.The lowest blood pressure and the slowest heart rate occurred in the 25~45 minutes after infusion of dexmedetomidine.After of treatment,oxygenation were improved,pulse oxygen saturation(SpO2)and subclavian venous blood oxygen partial pressure(PvO2)were significantly rised(P<0.05),PvO2 and subclavian venous blood oxygen saturation(SvO2)maintain smooth during operation.Subclavian venous blood CO2 partial pressure(PvCO2),lactic acid(Ralv),blood sugar(GLUv)continue to rise,compared with t 0,PvCO2 were increased at t c,the differences were statistically(P<0.05).Conclusion:Continuous pumping of small doses dexmedetomidine can maintain oxygen supply/consumption balance during PKP in elderly patients,reduce the cycle fluctuation and cardiovascular accident.Merger of COPD patients carries the risk of the accumulation of carbon dioxide.