右美托咪定对老年高血压全麻病人围手术期心肌的保护作用  

Effect of dexmedetomidine on myocardial protection in elderly hypertension patients under general anesthesia in perioperative period

作　　者：杨华[1] 陈海燕[1] 沈袁东 刘雯[1] 程华春[1] 

机构地区：[1]上海市杨浦区市东医院麻醉科,上海200438

出　　处：《安徽医药》2017年第4期721-724,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨右美托咪定(DEX)在老年高血压全麻病人围手术期的应用效果及其对心肌的保护作用。方法将86例拟行手术治疗的老年高血压病人按随机数字表法分为观察组和对照组,各43例。两组均采用全身麻醉及术后静脉自控镇痛(PCIA),观察组全麻诱导前给予DEX 0.5μg·kg^(-1)。观察两组病人血流动力学变化、术后镇痛镇静效果及心肌损伤情况。结果观察组T1~T5时刻心率(HR)、收缩压(SBP)、舒张压(DBP)与T0时刻均差异无统计学意义(P>0.05),且观察组各血流动力学指标均明显优于对照组(P<0.05);与对照组比较,观察组术后舒芬太尼用量显著减少,有效按压次数、Ramsay镇静评分显著升高(P<0.05);术毕,两组缺血修饰白蛋白(IMA)、心肌肌钙蛋白Ⅰ(c TnⅠ)均较术前显著升高,观察组术毕、术后24 h IMA、cTnI均明显低于对照组(P<0.05)。结论 DEX有助于维持老年高血压全麻病人围手术期间的血流动力学稳定,提高术后镇痛镇静效果,减轻心肌损伤。Objective To explore the effect of dexmedetomidine （DEX） in elderly patients with hypertension under general anesthesia in perioperative period, and analyze the effect on myocardial protection. Methods Eighty-six elderly hypertension patients undergoing surgery treatment were randomly assigned into two groups （n=43）. All the patients were given general anesthesia and postoperative pa-tient-controlled intravenous analgesia （PCIA） ,and experiment group was given 0. 5 μg·kg^-1 DEX before anesthesia induction. The hemodynamic, postoperative analgesia, sedation effect and myocardial damage between two groups were observed. Results Compared with TO moment, SBP, DBP, HR at T1-T5 moments in experiment group had no significant difference （ P 〉 0. 05 ） ,and they were signifi-cantly better than those in control group （P 〈0.05）. Compared with control group,the effective rate of PCEA bump and Ramsay score were increased,dose of sufentanil was significantly reduced in experiment group （P 〈 0. 05 ） . The levels of IMA, cTnl were significantly increased at the end of surgery compared with before surgery. Experiment group had lower levels of IMA, cTnl than control group at the end of surgery and 24 h after surgery （ P 〈 0. 05 ） . Conclusions DEX contributes to maintaining perioperative hemodynamic stability in elderly hypertension patients under general anesthesia,improving the effect of postoperative analgesia and calm,and relieving myocar-dial injury.

关 键 词：高血压 老年 全身麻醉 右美托咪定 心肌保护 

分 类 号：R614.2[医药卫生—麻醉学]