右美托咪定对丙泊酚麻醉下无抽搐电休克治疗老年患者麻醉恢复质量的影响

Effect of dexmedetomidine on quality of recovery from anesthesia in elderly patients undergoing electroconvulsive therapy with propofol anesthesia

目的:评价右美托咪定对丙泊酚麻醉下无抽搐电休克治疗老年患者麻醉恢复质量的影响。方法:择期拟于丙泊酚麻醉下行无抽搐电休克治疗患者60例,年龄>65岁,体重45~80 kg,ASA分级Ⅰ或Ⅱ级,性别不限。采用随机数字表法分为2组(n=30):对照组(C组)和右美托咪定组(D组)。麻醉诱导前即刻,D组经10 min静脉输注右美托咪定0.2μg/kg,C组输注等量生理盐水。随后缓慢静脉注射丙泊酚1.0~1.5 mg/kg,待睫毛反射消失后,静脉注射琥珀胆碱0.7 mg/kg,面罩加压给氧辅助人工通气。当患者去极化肌颤搐消失时移去面罩,采用电休克治疗仪进行治疗并监测脑电图。电休克治疗时根据患者年龄设置治疗电量,首次电量设置为患者年龄的0.5倍,当抽搐发作抑制指数<80%时,下一次治疗电量提高一档(每档相差电量25.2 mc,即总电量的5%)。治疗结束后,立即予面罩加压人工通气,待自主呼吸完全恢复时转入PACU。记录患者自主呼吸恢复时间、苏醒时间;记录患者麻醉恢复期不良心血管事件、恶心呕吐、呼吸抑制、头痛、嗜睡、躁动和谵妄的发生情况。结果:与C组比较,D组患者麻醉恢复期躁动、谵妄、高血压和心动过速的发生率降低(P<0.05),余指标差异无统计学意义(P>0.05)。结论:右美托咪定可改善丙泊酚麻醉下无抽搐电休克治疗老年患者的麻醉恢复质量。

Objective To evaluate the effect of dexmedetomidine on the quality of recovery from anesthesia in elderly patients undergoing electroconvulsive therapy(ECT)with propofol anesthesia.Methods Sixty patients of both sexes,aged>65 yr,weighing 45-80 kg,of American Society of Anesthesiologists physical statusⅠorⅡ,scheduled for elective ECT with propofol anesthesia,were assigned into 2 groups(n=30 each)using a random number table method:control group(group C)and dexmedetomidine group(group D).Dexmedetomidine was intravenously infused in a dose of 0.2μg/kg(in normal saline 10 ml)over 10 min starting from onset of anesthesia induction in group D,while normal saline 10 ml was given instead in group C.Propofol 1.0-1.5 mg/kg was intravenously injected slowly.Succinylcholine 0.7 mg/kg was intravenously injected after the eyelash reflex disappeared,and oxygen was delivered via a mask to assist artificial ventilation.The mask was removed when the muscle twitching disappeared during depolarization,treatment was performed with an ETC apparatus,and electroencephalogram was monitored.The electrical stimulus intensity was set according to the age of the patient during ECT treatment,and the initial intensity was set at 0.5 times the age of the patient.When the postictal suppression index was less than 80%,a higher level of stimulus intensity was used in the next ECT treatment(the difference between adjacent intensity levels was 25.2 mc,which was 5%of the total stimulus intensity).After the end of ECT procedure,participants were manually ventilated with a mask,and the patients were transferred to postanesthesia care unit when the spontaneous breathing was completely restored.The time to recovery of spontaneous breathing and emergence time were recorded.The development of adverse cardiovascular events,nausea and vomiting,respiratory depression,headache,drowsiness,agitation and delirium during recovery from anesthesia was also recorded.Results Compared with group C,the incidence of agitation,delirium,hypertension and tachycardia during recovery from anesthesia was significantly decreased,and no significant change was found in the other variables in group D(P<0.05).Conclusion Dexmedetomidine can improve the quality of recovery from anesthesia in elderly patients undergoing ECT under propofol anesthesia.