不同剂量右美托咪定在老年患者全麻苏醒期的应用  

Effects of different doses of Dexmedetomidine on stress reflect during general anesthesia recovery period in elderly patients

作　　者：于铁莉[1] 岳文慧[1] 王金城[2] 李艳[1] 李汝泓[1] 张晓侠[1] 王志学[1] 

机构地区：[1]河北承德医学院附属医院,承德067000 [2]河北医科大学第三医院,石家庄050000

出　　处：《临床药物治疗杂志》2015年第1期32-35,共4页Clinical Medication Journal

摘　　要：目的:观察不同剂量右美托咪定对老年患者全麻苏醒期应激反应的影响。方法:选择60例择期行胃癌根治术的老年患者,随机分为3组,每组各20例。中剂量组(D1组)插管毕右美以0.5μg·kg-1·h-1的速度持续泵入至缝皮前;高剂量组(D2组)速度为0.8μg·kg-1·h-1;C组为对照组给予等量的生理盐水。记录3组病人:手术结束时(T1)、拔管后即刻(T2)、拔除气管导管后5 min(T3)各时点心率(HR)、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、血浆皮质醇(Cor)和血糖(Glu)浓度。记录不良反应如:高血压、心动过缓、寒颤等的例数和拔管时间。结果:T2时点C组HR,SBP,DBP,MAP明显高于D1,D2组(P<0.05);T3时点C组的Cor,Clu浓度高于D1,D2组(P<0.05)。组内比较:C组各时点血流动力学波动明显(P<0.05),而D1,D2组波动不大(P>0.05)。不良反应及拔管时间D2组明显大于D1组。结论:中剂量右美托咪定能更好抑制老年患者全麻苏醒期的应激反应。Objective： To investigate the effects of different doses of Dexmedetomidine on stress reflect during general Anesthesia recovery period in elderly patients. Methods： 60 elderly patients with gastric cancer underwent radical extirpation were included. They were randomly divided into three groups （n=20 each）： control group （group C）; median and high doses of Dexmedetomidine groups （group D1-2）. The dose of Dexmedetomidine in group D1 and group D2 were 0.5 μg.kg-1·h-1 and 0.8 μg·kg-l·h-1 respectively, infused from endotracheal intubation until suturing skin. While group C was administrated with the same amount of physiological saline. The parameters of heart rate （HR）, systolic blood pressure （SBP）, diastolic blood pressure （DBP） and mean arterial pressure （MAP） were recorded at the following moment ： the end of the surgery （T1）, extubation （T2） and 5min after extubation （T3）. And at the meantime, corticosteroid （Cor） and glucose （Glu） of the arterial blood were measured. Documented the time of extubation and the adverse reactions e.g. hypertension, bradycardia, chills and so on. Results： The parameters of hemodynamic at T2 in Group C is significantly higher than group D1 and D2 （P 〈 0.05）, and the Cor and Glu level at T3 in group C were also higher than the two groups （P〈0.05）. Compared within group, the hemodynamic parameters at each time point is significantly different （P〈0.05） within group C, but there were little change within group D1 and D2 （P 〉 0.05）. The adverse reactions in group D2 were more than group D1. The extubation time of group D2 is longer than group D1 and C （P 〈0.05）. Conclusion： Continuous infusion of median dose of Dexmedetomidine could better control the stress reflect in the elderly patients undergoing general anesthesia recovery.

关 键 词：盐酸右关托咪定 血流动力学 应激反应 血糖 皮质醇 

分 类 号：R971.2[医药卫生—药品]