右美托咪定复合氢吗啡酮在老年白内障手术患者无插管全麻中的应用

Application of dexmedetomidine combined with hydromorphone in non-intubated general anesthesia for elderly patients undergoing cataract surgery

目的探讨右美托咪定复合氢吗啡酮在老年白内障手术患者无插管全麻中的应用效果。方法选择2022年3月—2023年5月本院收治的92例拟行白内障手术的老年患者为研究对象,随机分为右美托咪定组和丙泊酚组两组,每组各46例。丙泊酚组患者予以丙泊酚复合氢吗啡酮,右美托咪定组患者予以右美托咪定复合氢吗啡酮。比较两组患者麻醉效果、术中补救麻醉次数、血流动力学、镇静镇痛评分、眼内压以及苏醒时间、苏醒期躁动以及不良反应。结果两组患者麻醉总有效率比较,差异无统计学意义(P>0.05);右美托咪定组患者术中补救麻醉次数低于丙泊酚组,差异有统计学意义(P<0.05);两组患者T0时间点HR、MAP比较,差异均无统计学意义(P>0.05);右美托咪定组患者T_(1)~T_(3)时间点HR、MAP均低于T0时间点,差异有统计学意义(P<0.05);右美托咪定组患者T2时间点低于T_(3)~T_(4)时间点,差异有统计学意义(P<0.05);丙泊酚组患者T_(1)~T_(4)时间点HR、MAP均低于T0时间点,差异有统计学意义(P<0.05);丙泊酚组患者T_(1)~T_(3)时间点HR、MAP均低于T_(4)时间点,差异有统计学意义(P<0.05);右美托咪定组患者T_(1)~T_(4)时间点HR、MAP均高于丙泊酚组,差异有统计学意义(P<0.05);两组患者术后4 h、8 h时VAS评分均高于术后2 h,差异有统计学意义(P<0.05);两组患者术后8 h、12 h时VAS评分均低于术后4 h,差异有统计学意义(P<0.05);两组患者术后12 h时VAS评分低于术后8 h,差异有统计学意义(P<0.05);右美托咪定组患者术后2 h、4 h、8 h、12 h时VAS评分均低于丙泊酚组,差异有统计学意义(P<0.05);两组患者术后2 h、4 h、8 h、12 h时Ramsay评分组间和组内比较,差异无统计学意义(P>0.05);两组患者麻醉前、术前、术后1 d眼内压组间和组内比较,差异均无统计学意义(P>0.05);两组患者术中眼内压均高于麻醉前、术前、术后1 d,差异有统计学意义(P<0.05);且右美托咪定组患者麻醉前、术前、术中、术后1 d眼内压均低于丙泊酚组,差异有统计学意义(P<0.05);两组患者苏醒时间比较,差异无学统计学意义(P>0.05);右美托咪定组患者苏醒期躁动发生率(0.00%)低于丙泊酚组(13.04%),差异有统计学意义(P<0.05);两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论右美托咪定复合氢吗啡酮应用于老年白内障手术患者无插管全麻中效果显著,可稳定血流动力学和眼压波动,减少术中补救麻醉次数,降低苏醒期躁动,且安全性良好。

Objective To explore the application effect of dexmedetomidine combined with hydromorphone in non-intubated general anesthesia for elderly cataract surgery patients.Methods Ninety-two elderly patients admitted to our hospital from March 2022 to May 2023 for cataract surgery were selected as study subjects and randomly divided into two groups:the propofol group(46 cases)and the dexmedetomidine group(46 cases).The propofol group received propofol combined with hydromorphone,while the dexmedetomidine group received dexmedetomidine combined with hydromorphone.The anesthesia effects,intraoperative anesthesia addition frequency,hemodynamics,sedative and analgesic scores,intraocular pressure,awakening time,restlessness during awakening,and adverse reactions between the two groups were compared.Results There was no statistically significant difference in the total effective rate of anesthesia between the two groups(P>0.05).The number of intraoperative anesthesia additions in the dexmedetomidine group was lower than that in the propofol group(P<0.05).There was no significant difference in HR and MAP at T 0 time point between the two groups(P>0.05).HR and MAP of patients in the dexmedetomidine group at T_(1)to T_(3)time points were lower than those at T0 time point,with statistical significance(P<0.05).HR and MAP in the dexmedetomidine group at T2 time point were lower than those at T_(3)and T_(4)time points,with statistical significance(P<0.05).HR and MAP of patients in the propofol group at T_(1)to T_(4)were lower than those at T 0,with statistical significance(P<0.05).HR and MAP of patients in the propofol group at T_(1)to T_(3)time points were lower than those at T4 time point,with statistical significance(P<0.05).HR and MAP at T_(1)to T_(4)time points in the dexmedetomidine group were higher than those in the propofol group,with statistical significance(P<0.05).VAS scores at 4th and 8th hours after surgery were higher than those at 2nd hour after surgery,with statistical significance(P<0.05).VAS scores at 8th and 12th hours postoperative were lower than those at 4th hour postoperative,with statistical significance(P<0.05).VAS scores in the dexmedetomidine group at 2nd,4th,8th,and 12th hours postoperative were lower than those in the propofol group,with statistical significance(P<0.05).There was no significant difference in Ramsay scores at 2 h,4 h,8 h,and 12 h after surgery between groups and within groups(P>0.05).Intraocular pressure(IOP)in both groups was higher during surgery than before anesthesia,before surgery,and 1 day after surgery,with statistical significance(P<0.05).The intraocular pressure in the dexmedetomidine group before anesthesia,before operation,during operation,and 1 day after operation was lower than that in the propofol group,with statistical significance(P<0.05).There was no significant difference in the recovery time between the two groups(P>0.05).The incidence of agitation during recovery in the dexmedetomidine group(0.00%)was lower than that in the propofol group(13.04%),with statistical significance(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions The combination of dexmedetomidine and hydromorphone is effective in non-intubated general anesthesia for elderly cataract surgery patients,stabilizing hemodynamics and intraocular pressure fluctuations,reducing the number of intraoperative anesthesia additions,and decreasing restlessness during the recovery period,with good safety.