右美托咪定滴鼻对肾功能不全老年患者全身麻醉苏醒期躁动的影响

Effect of intranasal dexmedetomidine on emergence agitation during general anesthesia in elderly patients with renal insufficiency

目的探究右美托咪定滴鼻对肾功能不全老年患者全身麻醉苏醒期躁动的影响。方法选取2023年2月至2024年2月河北省唐山中心医院收治的100例老年肾功能不全胃肠手术的患者作为研究对象,并完全随机分为2组,每组50例。观察组患者手术结束前1 h,给予右美托咪定滴鼻。对照组患者手术结束前1 h,给予等容积的0.9%氯化钠注射液滴鼻。比较2组患者麻醉恢复指标、疼痛程度、镇静效果、肾功能指标和不良反应情况。结果观察组患者自主呼吸恢复时间和麻醉苏醒时间均短于对照组(均P<0.05)。观察组患者在麻醉苏醒后6、12、24、48 h的视觉模拟量表评分均低于对照组(均P<0.001)。观察组患者拔管时即刻、拔管后5、30、60 min的镇静Ramsay评分均高于对照组(均P<0.001)。观察组患者术后的血尿素氮、血肌酐、24 h尿微量白蛋白、24 h尿白蛋白排泄率均低于对照组(均P<0.001)。观察组不良反应总发生率明显低于对照组[8.0%(4/50)比46.0%(23/50),χ2=18.316,P<0.001]。结论在老年肾功能不全患者全身麻醉手术中应用右美托咪定滴鼻,麻醉镇痛镇静效果好,可有效缩短呼吸恢复时间和麻醉复苏时间,减少麻醉苏醒期躁动,肾功能指标恢复良好,不良反应少,安全有效。

Objective To investigate the effect of intranasal dexmedetomidine on emergence agitation during general anesthesia in elderly patients with renal insufficiency.Methods A total of 100 elderly patients with renal insufficiency undergoing gastrointestinal surgery in Tangshan Central Hospital,Hebei Province from February 2023 to February 2024 were selected as the research objects,and were randomly divided into two groups,with 50 cases in each group.Patients in the observation group were given intranasal dexmedetomidine 1 h before the end of surgery.Patients in the control group were given the same volume of 0.9%sodium chloride injection nasal drops 1 h before the end of surgery.The anesthesia recovery index,pain degree,sedation effect,renal function index and adverse reactions were compared between the two groups.Results The recovery time of spontaneous breathing and anesthesia recovery time in the observation group were shorter than those in the control group(both P<0.05).The visual analogue scale scores of the observation group were lower than those of the control group at 6,12,24 h and 48 h after anesthesia recovery(all P<0.001).The Ramsay scores of sedation immediately,5,30 and 60 min after extubation in the observation group were higher than those in the control group(all P<0.001).The levels of blood urea nitrogen,serum creatinine,24 h urinary albumin and 24 h urinary microalbumin excretion rate in the observation group were lower than those in the control group(all P<0.001).The total incidence of adverse reactions in the observation group was significantly lower than that in the control group[8.0%(4/50)vs 46.0%(23/50),χ2=18.316,P<0.001].Conclusion The application of intranasal dexmedetomidine in patients with renal insufficiency undergoing general anesthesia has good anesthetic analgesic and sedative effects,which can effectively shorten the time of respiratory recovery and anesthesia recovery,reduce restlessness during anesthesia recovery,good recovery of renal function level,less adverse reactions,and is safe and effective.