右美托咪定对老年上腹部手术气管拔管及术后镇痛的影响  

Effects of dexmedetomidine on extubation and analgesia in elderly patients after upper abdominal surgery

作　　者：郭继龙[1] 王光磊[1] 齐敦益[1] 刘功俭[1] 

机构地区：[1]徐州医学院附属医院麻醉科,江苏徐州221002

出　　处：《徐州医学院学报》2015年第4期246-248,共3页Acta Academiae Medicinae Xuzhou

摘　　要：目的观察右美托咪定对老年上腹部手术气管拔管及术后镇痛的影响。方法选择ASAⅡ-Ⅲ级，择期行上腹部手术患者40例。随机分为右美托咪定组和对照组。右美托咪定组在诱导前泵注1μg·kg^-1右美咪定，术中持续泵注0．3μg·kg^-1右美托咪定；对照组给予同样容量的生理盐水。2组患者麻醉方法相同。术毕连接镇痛泵[（舒芬太尼2μg·kg^-1＋盐酸托烷司琼6mg）／100ml]。术中连续观察收缩压（SBP）、舒张压（DBP）、心率（HR）和脉搏氧饱和度（SpO2）；记录清醒时间、苏醒期并发症及苏醒期血流动力学指标变化情况；拔管后即刻，术后30min、2h、6h、12h，由同一位麻醉医生对患者进行视觉模拟（VAS）评分。结果2组患者在手术结束时血压、HR无明显差别，拔管前5min、拔管时、拔管后5min2组差异明显（P〈0．05）；对照组患者各时点VAS评分明显高于右美托咪定组（P〈0．05或P〈0．01）；对照组患者躁动发生率明显高于右美托咪定组（P〈0．05）。结论右美托咪定用于老年患者苏醒期拔管，具有稳定血流动力学作用，且不影响苏醒时间，同时还有一定的辅助镇痛作用。Obiective To investigate the effects of dexmedetomidine on extubation and analgesia in elderly patients after upper abdominal surgery. Methods Forty elderly patients （22 men and 18 women） who aged 65 - 85 with ASA Ⅱ - Ⅲwere randomly divided into two groups before upper abdominal surgery. One group was treated with 1μg·kg^-1 dexmedetomidine before anesthesia induction followed by 0.3 μg·kg^-1 dexmedetomidine during operation （ group D） , while the other group （group C） was infused with the same volume of normal saline. Given the identical methods of anesthesia, both groups were provided with patient - controlled analgesia using sufentanil （2μg·kg^-1） and tropisetron （6 mg） per 100 ml solution after operation. Clinical data like systolic blood pressure （SBP）, diastolic blood pressure （DBP）, heart rate （HR） and oxygen saturation （SpO2 ） were measured during surgery. Meanwhile, their recovery time, as well as complications and hemodynamic changes after awaking were also recorded. Also, all patients were assessed based on visual analogue scale （VAS） immediately, 30 min, 2 h, 6 h and 12 h after extubation. Results Both groups presented significant changes in blood pressure and heart rate 5 min before, immediately and 5 min after extubation （ P 〈 0.05 ） , rather than at the end of surgery. The administration of dexmedetomidine could result in remarkably lower scores of VAS in patients immediately, 30 min, 2 h, 6 h and 12 h after extubation, when compared with the control （P 〈0.05 or P 〈 0.01 ）. The dexmedetomidine group reported restlessness less frequently than the control （ P 〈 0.05 ）. Conclusion The administration of dexmedetomidine, when applied for extubation in elderly patients, can provide stable hemodynamic results and improve postoperative analgesia, without any influence on awaking time.

关 键 词：右美托咪定 气管拔管 老年 术后镇痛 

分 类 号：R654.1[医药卫生—外科学]