小剂量右美托咪定在老年全麻拔管期间的临床应用  

Effect of using low-dose Dexmedetomidine during tracheal extubation for elderly patients after general anesthesia

作　　者：曾兆东[1] 许德奖[1] 庄少惠[1] 林树勇[1] 程明华[1] 

机构地区：[1]汕头大学医学院第一附属医院麻醉科,515000

出　　处：《中国现代药物应用》2014年第1期1-3,共3页Chinese Journal of Modern Drug Application

基　　金：广东省科技计划发展项目(项目编号:2010B080701092)

摘　　要：目的研究盐酸右美托咪定(Dex)单次剂量在老年患者全麻拔管期间的应用效果。方法择期手术老年患者40例,随机分成D组(右美托咪定组)和C组(生理盐水组)。麻醉方法为静脉靶控输注瑞芬太尼和丙泊酚,静注维库溴铵维持肌松。手术结束前10 min D组给予Dex 0.5μg/kg(生理盐水稀释至50 ml),C组给予50 ml的生理盐水。观察并记录所有患者拔管期间的HR、SBP、DBP、SPO2,记录各时点的Ramsay镇静评分、拔管时间及其他不良事件发生情况。结果两组拔管时间差异无统计学意义(P>0.05);与基础值相比,用药后D组HR显著降低(P<0.05),SBP、DBP差异无统计学意义(P>0.05),拔管时HR、SBP、DBP均略有上升,拔管后5、10 min时HR、SBP、DBP与诱导前差异无统计学意义(P>0.05);C组HR、SBP、DBP在苏醒拔管期间均显著高于诱导前,且高于D组(P<0.05)。右美托咪定用于老年患者苏醒期间D组Ramsay评分显著高于C组(P<0.05)。所有患者在拔管期间均无缺氧、呼吸抑制和气道痉挛发生。结论右美托咪定用于老年患者苏醒期拔管,血流动力学稳定,且不影响拔管时间。Objective To study the effect of using low-dose of dexmedetomidine during tracheal extu- bation in elderly patients recovering from general anesthesia. Methods Forty elderly patients, ASA I ~ 1], scheduled for the surgery under general anesthesia, were participated in one of the two randomized trials ： con- trol group （ group C, n = 20, NS group） and observation Groups （ group D, n = 20, dexmedetomidine 0.5 ug/ kg）. All patients received continuous monitoring of HR, BP and SPOz to detect the depth of anesthesia. After the induction of anesthesia, endotracheal intubation was performed and patients were given propofol and remifentanil given by target-controlled infusion （TCI） to maintain deep anesthesia, keep BIS between 40 and 60,10 minutes before the end of surgery, patients in group D and group C were infused dexmedetomidine 0. 5 I^g/kg, and the same volume of normal saline, respectively, within 10 minutes. All the indicators closely moni- tored and recorded included： SBP, DBP, HR at every time-point. Time periods of experiment were recorded as follow： tl （time between the end of surgery to extubation）, recovery time t2 （the time after extubation until pa- tients could manage instructional activity ）. Sedation was assessed by Ramsay Post treatment of reverse reaction caused by extubation was also closely recorded. Results HR in group D were significantly lower than that based on the numerical （P 〈 0.05）. HR SBP and DBP in group C were significantly higher than based on the numerical and data of group D （P 〈 0.05）. Conclusion Application of single infusion of 0. 5 ug/kg dexme- detomidine into eldly patients at extubation period can stabilize the hemodynamics, and would not prolong the extuabtion and recovery time.

关 键 词：右美托咪定 维库溴铵 老年 

分 类 号：R614[医药卫生—麻醉学]