小剂量右美托咪定用于老年手术患者镇静对心功能的影响  

Effects of sedation with low-dosage dexmedetomidine on cardiac function in elderly surgical patients

作　　者：郎宇[1] 王天龙[1] 

机构地区：[1]首都医科大学宣武医院麻醉科,北京100053

出　　处：《解放军医学杂志》2011年第9期976-979,共4页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨在老年患者椎管内麻醉中连续输注小剂量右美托咪定（DEX）镇静对心功能指标的影响。方法 60例老年手术患者（男24例,女36例;年龄65~89岁,平均77岁）;随机分为DEX组和对照组（n=30）。桡动脉穿刺测压建立后,连接动脉血压连续监测心输出量（APCO）监护仪,持续监测心功能指标[心输出量指数（CI）、每博指数（SVI）、心率（HR）和平均动脉血压（MAP）];椎管内麻醉完成后,DEX组经静脉持续输注DEX,速度为0.4μg/（kg.h）,10min后输注速度调整为0.2~0.4μg/（kg.h）,将脑电双频谱指数（BIS）值控制在75~85。对照组持续输注等容积生理盐水。记录给药即刻（T0）、给药后10min（T1）、20min（T2）、30min（T3）、60min（T4）及术毕时（T5）的MAP、HR、呼吸频率（RR）、脉搏血氧饱和度（SpO2）、呼气末二氧化碳分压（PETCO2）及BIS值,同时记录心输出量/心指数（CO/CI）、每搏量/每搏指数（SV/SVI）、HR和MAP值,并进行统计学分析。结果麻醉期间循环、呼吸参数均在正常范围内。给药10mim后与给药即刻相比,DEX组动脉收缩压（SAP）下降7%~11%（P〈0.05）,对照组无明显改变（P〉0.05）。DEX组给药后组内（与T0相比）和组间（与对照组相比）BIS值均显著降低（P〈0.05）;两组患者在组内、组间各时间点CO/CI、SV/SVI水平的比较均无明显差异（P〉0.05）。结论老年患者椎管内麻醉期间持续输注小剂量DEX镇静对心功能指标影响轻微。Objective To investigate the influence of continuous infusion of low-dose dexmedetomidine（DEX） for sedation on cardiac function index in elderly surgical patients,and assess the impacts on circulation.Methods Sixty elderly surgical patients were randomized into DEX group and control group（30 each）.The sex ratio of the patients was 24/36（male/female）,and age from 65 to 89 years.After the cannulation of left radial artery,the arterial pressure continuous cardiac output（APCO） monitor（Edwards,USA） was connected,and the cardiac function index was continuously monitored,including cardiac output index（CI）,stroke volume index（SVI）,heart rate（HR） and mean arterial pressure（MAP）.The patients in DEX group were infused with DEX at 0.4μg（kg·h） for 10min following intrathecal anesthesia,then the infusion rate was adjusted from 0.2 to 0.4μg（kg·h） to keep the bispectral index values（BIS） maintained between 75 and 85.Normal saline was administered with an equal volume in control group.The MAP,HR,respiration rate（RR）,pulse oxygen saturation（SpO2）,the partial pressure of end-tidal carbon dioxide（PETCO2） and BIS were recorded immediately at the DEX infusion（T0）,and 10min（T1）,20min（T2）,30min（T3）,60min（T4） after DEX infusion,and the end of surgery（T5）.All cardiac function data were statistically analyzed,and P0.05 was considered as statistic significance.Results All hemodynamic and respiratory parameters in both groups were normal during operation.When DEX infusion was given for 10min,the systolic blood pressure（SBP） in DEX group was lowered by about 7%-11% compared with that in T0（P0.05）,but such change was not observed in control group.The BIS values in DEX group declined significantly in T1-5 groups compared with that in T0 and control group（P0.05）.No significant difference of CO/CI and SV/SVI was found within various time points or between the two groups（P0.05）.Conclusion The sedation with continuous infusion of small-dosage DEX

关 键 词：老年人 右美托咪定 镇静 

分 类 号：R614.41[医药卫生—麻醉学]