右美托咪定与瑞芬太尼预防老年患者术后拔管反应临床对比

Comparison of the effect of dexmedetomidine versus remifentanil for preventing extubation reaction in elderly patients

目的比较右美托咪定(DEX)与瑞芬太尼(REM)对老年患者行腹腔镜胆囊切除术术后拔管反应的影响.方法选取2019年12月~2020年3月择期行腹腔镜胆囊切除术的老年患者54例,分为DEX组(D组)和REM组(R组),每组27例,年龄65~80岁,体质指数(BMI)22~30kg/m2,两组患者均使用靶控输注REM和丙泊酚诱导,术中以1%~2%七氟烷和REM 0.1~0.2μg·kg-1·min-1维持麻醉,D组以0.5μg/kg负荷量泵入DEX 10min后改为维持量至拔管,在手术结束前,将R组REM持续量降低为0.05μg·kg-1·min-1直至拔管.观察两组患者在苏醒期停药时(T0)、拔管即刻(T1)、拔管后1min(T2)、3min(T3)、5min(T4)的血流动力学变化及呛咳、高血压、心动过速的发生率.结果R组患者在T1、T2、T3时的平均动脉压(MAP)和心率(HR)变化更小,与D组比较差异有统计学意义(P<0.05).R组在抑制苏醒期呛咳、高血压、心动过速方面显著优于D组(P<0.05).结论REM持续输注能够较好地抑制拔管引起的血流动力学变化,并能减少老年患者苏醒期发生应激反应,效果优于DEX.

Objective To compare the effect of dexmedetomidine(DEX)versus remifentanil(REM)on inhibiting the extubation reaction of elderly patients during resuscitation.Methods 54 elderly patients who underwent selective laparoscopic cholecystectomy from Dec 2019 to Mar 2020 were selected,and divided into DEX group selective(group D)and REM group(group R),27 cases in each group,aged 65~80,body mass index(BMI)22~30 kg/m2.All patients were induced by target-controlled infusion of remifentanil and propofol.During the operation,anesthesia was maintained with 1%~2%sevoflurane and remifentanil 0.1~0.2μg·kg-1·min-1.Group D was pumped dexmedetomidine at 0.5μg/kg load for 10 minutes and then changed to maintain the volume until extubation.Before the end of surgery,the continuous amount of remifentanil in group R was reduced to 0.05μg·kg-1·min-1 until extubation.Observed the hemodynamic changes,the incidence of cough,hypertension and tachycardia in the two groups during the recovery period at T0,T1,T2,T3 and T4 after extubation.Results The changes in mean arterial pressure(MAP)and heart rate(HR)in group R at T1,T2 and T3 were smaller compared with group D,and the difference was statistically significant(P<0.05).The group R was significantly better than group D in suppressing cough,hypertension,tachycardia during recovery period(P<0.05).Conclusion The continuous infusion of remifentanil can better inhibit hemodynamic changes caused by extubation and reduce the stress response of elderly patients during the recovery period,which is better than dexmedetomidine.