小剂量右美托咪定术前用药对全麻高血压患者的效果及安全性研究  

The Effect of Low Dose of Dexmedetomidine as Preoperative Medication on Patients with Hypertension Undergoing General Anesthesia and the Safety

作　　者：李雪刚[1] 刘玉林 

机构地区：[1]宜宾市第一人民医院麻醉科,四川宜宾644000 [2]西南医科大学附属医院麻醉科,泸州

出　　处：《西南军医》2016年第4期304-307,共4页Journal of Military Surgeon in Southwest China

摘　　要：目的研究小剂量右美托咪定(0.3ug/kg)作为全麻高血压患者术前用药的有效性和安全性。方法选择择期全麻高血压患者40例,按照随机双盲设计分为右美托咪定组(DEX组)和生理盐水组(NS组),每组各20例。两组患者均提前30min在病房内泵注术前用药:20ml右美托咪定稀释液用于DEX组,20ml生理盐水用于NS组,约10min泵完。记录两组患者在以下各时间点的HR、SBP和DBP,以及RR、SPO2和Ramsay镇静评分:给药前(TO)、泵注后10min(T1)、入手术室即刻(T2)、诱导前(T3)、诱导后(T4)和插管即刻(T5),并对阿托品、麻黄碱和乌拉地尔的使用情况进行记录。结果 DEX组在T1、T2、T3、T4和T5的HR、SBP和DBP的波动幅度明显小于NS组(P<0.05),在T1、T2、T3各时间点的Ramsay镇静评分明显高于NS组(P<0.05),而RR和SPO2则改变不明显(P>0.05),两组患者阿托品、麻黄碱和乌拉地尔的使用率在病房内均为0,在手术室内阿托品和麻黄碱的使用率无统计学意义(P>0.05),而NS组乌拉地尔使用率明显增加(P<0.05)。结论小剂量DEX作为术前用药可以产生良好的镇静、抗焦虑和抑制交感兴奋等作用,能在一定程度上降低入室后及诱导期间血流动力学的波动。Objective To explore the effect of low dose of dexmedetomidine （DEX） as preoperative medication on patients with hy- pertension undergoing general anesthesia and the safety. Methods 40 cases with hypertension undergoing general anesthesia in selective operations were divided into 2 groups： DEX group and NS group, 20 cases in each; the preoperative medication was injected by pump-ing, within 10 minutes, in cases in the 2 groups in the ward 30 minutes before entering the operating room： diluted DEX for cases in DEX group while normal saline for cases in NS group; HR, SBP, DBP, RR, SPO2 and Ramsay sedation scores of the cases in both groups at each time point were recorded： TO （before performance）, TI（10 minutes after pumping）, T2（immediately after entering opera- tion room）, T3 （before anesthetic induction）, T4 （after anesthetic induction） and T5 （immediately after intubation）; the application of at- ropine, ephedrine and urapidil in the 2 groups was recorded as well. Results The fluctuation amplitudes of HR, SBP and DBP of the cas- es in DEX group at each time point were much smaller than those of the cases in NS group （P〈0.05） and the Ramsay sedation scores of the cases in DEX group at the time point ofT1, T2 and T3 were much higher than those of the cases in NS group （P〈0.05）; the changes of RR and SPO2 were not obvious （P〈0.05）; no application of atropine, ephedrine and urapidil was made in the ward, the application of atropine and ephedrine in operation room was of no statistical significance （P〈0.05） while the application rate ofurapidil in cases in NS group was obviously higher （P〈0.05）. Conclusions Low dose of DEX as preoperative medication is of good effect in sedation, anti-anxi- ety and inhibiting sympathetic nerve excitement, it can reduce the hemodynamic fluctuations of the patients after entering operation room and during anesthetic induction.

关 键 词：右美托咪定 高血压患者 全麻 术前用药 血流动力学 

分 类 号：R544.1[医药卫生—心血管疾病]