右美托咪定用于高龄患者腹腔镜胆囊切除术术中的麻醉维持效果及患者血流动力学情况观察  

Effect of dexmedetomidine on maintenance of anesthesia and hemodynamics in elderly patients undergoing laparoscopic cholecystectomy

作　　者：丁雷鸣[1] 王武[1] 雷李培[1] 李军[2] Lei-Ming Ding;Wu Wang;Li-Pei Lei;Jun Li(Department of Anesthesiology, Lishui Central Hospital, Lishui 323000, Zhejiang Province, Chin;Department of Anesthesiology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China)

机构地区：[1]丽水市中心医院麻醉科,浙江省丽水市323000 [2]温州医科大学附属第二医院麻醉科,浙江省温州市325000

出　　处：《世界华人消化杂志》2018年第18期1125-1131,共7页World Chinese Journal of Digestology

摘　　要：目的探讨右美托咪定在高龄患者腹腔镜胆囊切除术术中的麻醉维持效果及患者血流动力学的情况.方法选取温州医科大学附属第二医院从2015-09/2017-09收治的100例行腹腔镜胆囊切除术且年龄大于70岁的患者,按照随机数字表法均分为两组:对照组50例,术中给予丙泊酚联合瑞芬太尼麻醉维持;观察组50例,术中给予右美托咪定联合瑞芬太尼麻醉维持.观察两组患者麻醉前(T0)、插入喉罩(T1)、手术开始(T2)、手术结束(T3)以及拔出喉罩(T4)等不同时间点的脑电双频指数(bispectral index,BIS)、心率(heart rate,HR)、收缩压(systolic blood pressure,SBP)和舒张压(diastolic blood pressure,DBP),苏醒后的视觉模拟评分法(visual analogue scale,VAS)和改良OAA/S评级以及两组患者不良反应的比较.结果两组患者在T0-T4不同时间点的BIS值差异无统计学意义(F=1.289,P=0.257);两组患者在T1-T4不同时间点,观察组患者HR、DBP以及SBP均明显低于对照组患者,差异具有统计学意义(F=806.7,P<0.001;F=75.55,P<0.001;F=445.5,P<0.001);两组患者苏醒VAS评级优良数分别为48例和50例,差异无统计学意义(χ~2=3.560,P=0.169);OAA/S评级分别为37例、11例、3例和40例、9例、1例,差异无统计学意义(χ~2=0.545,P=0.761);此外,两组不良反应总发生率分别为22.0%和18.0%,差异无统计学意义(χ~2=0.251,P=0.617).结论右美托咪定应用于高龄腹腔镜胆囊切除术患者的术中麻醉维持效果显著,可以有效维持血流动力学稳定,且安全可靠,值得在临床推广应用.AIM To explore the effect of dexmedetomidine on maintenance of anesthesia and hemodynamics in elderly patients undergoing laparoscopic cholecystectomy. METHODS One hundred patients aged 70 years who were treated from September 2015 to September 2017 at the Second Affiliated Hospital of Wenzhou Medical University were randomly divided into a control group（50 cases） and an observation group（50 cases）. All the patients received laparoscopic cholecystectomy. The control group was given propofol and remifentanil for anesthesia maintenance, and the observation group was given dexmedetomidine and remifentanil. Bispectral index（BIS）, heart rate（HR）, systolic blood pressure（SBP）, and diastolic blood pressure（DBP） before anesthesia（T0） and at insertion of mask（T1）, beginning of surgery（T2）, ending of surgery（T3）, and withdrawal of mask（T4） as well as visual analogue scale（VAS） after awakening, improved OAA/S ratings, and adverse reactions were observed. RESULTS There was no significant difference in BIS between the two groups at different time points from T0 to T4（P〈0.05）. At the time points of T1-T4, HR, DBP, and SBP of the observation group were significantly lower than those of the control group（P〈0.05）. There was no significant difference in VAS or improved OAA/S ratings between the two groups after resuscitation（P〈0.05）. In addition, there was no statistical difference in the incidence of adverse reactions between the two groups（P〈0.05）.CONCLUSION Treatment with dexmedetomidine in elderly patients undergoing laparoscopic cholecystectomy has a significant effect in maintaining intraoperative anesthesia and can effectively maintain hemodynamics with good safety.

关 键 词：腹腔镜胆囊切除术 右美托咪定 丙泊酚 脑电双频指数 血流动力学 视觉模拟评分法 

分 类 号：R614[医药卫生—麻醉学]