老年骨科手术患者右美托咪定遗忘镇痛慢诱导的临床观察  

Clinical observation on the slow induction analgesia with dexmedetomidine in elderly patients undergoing orthopedic surgery

作　　者：汪其武 杨恒 李蕾[1] 骆宏 WANG Qiwu;YANG Heng;LI lei;LUO Hong(Department of Anesthesiology,The First People＇s Hospital of Hefei City（West）,Hefei 230061,China)

机构地区：[1]合肥市第一人民医院西区麻醉科,安徽合肥230061 [2]合肥市滨湖医院麻醉科,安徽合肥230091

出　　处：《皖南医学院学报》2018年第4期387-390,共4页Journal of Wannan Medical College

摘　　要：目的:观察右美托咪定遗忘镇痛慢诱导用于老年骨科手术患者的临床效果。方法:老年患者择期骨科手术60例,采用随机数字表法随机分为慢诱导组(M组)和依托咪酯快诱导组(Y组),每组30例。观察并记录两组患者各时间点的MAP、HR,以诱导前为基础插管后3 min、10 min的皮质醇、β-EP变化幅度。观察并记录两组患者的不良反应,即术后躁动评分、拔管后咽喉痛、拔管即刻呛咳反应、肌肉颤动的例数、苏醒期患者的耐管性、肌肉松弛药的用量等。结果:与诱导前比较,Y组MAP、HR在T_1时点降低,在T_2、T_3时点升高(P<0.05);与M组比较,Y组MAP、HR在T_1时点降低,在T_2、T_3时点升高(P<0.05);与诱导前比较,Y组皮质醇、β-EP在插管后3 min、10 min后升高(P<0.05),M组皮质醇、β-EP在插管后3 min、10 min后降低(P<0.05);与Y组比较,M组皮质醇、β-EP在插管后3 min、10 min后降低(P<0.05);M组顺阿曲库铵的用量与Y组比较用量减少(P<0.05);与M组比较,Y组肌颤发生例数增加、躁动评分升高(P<0.05);Y组咽喉疼、呛咳反应发生率高于M组;M组气管导管耐受性高于Y组(P<0.05)。结论:右美托咪定遗忘镇痛慢诱导可以安全舒适地用于老年患者的全身麻醉,苏醒质量好,不良反应少,麻醉效果完善。Objective： To observe the clinical effect of slow analgesia induction with dexmedetomidine in elderly patients undergoing orthopedic surgery.Methods： Sixty elderly patients undergoing elective orthopedic surgery were equally divided into slow induction group（ Group M） and etomidate induction group（ Group Y） by random digital table. The data were kept in two groups on the mean arterial blood pressure（ MAP） and heart rate（ HR） at each time point,and level changes of cortisol and β-EP in 3 and 10 min before induction. The two group were also kept and observed on the adverse effects,postoperative restlessness score,sore throat after extubation,immediate cough response to extubation,number of muscle tremors,patient＇ s resistance to the tube withdrawal in awakening period and muscle relaxant dosage. Results： MAP and HR were decreased at T_1 and increased at T_3 and T_4 in group Y compared to the pre-induction and group M（ P〈 0. 05）. Cortisol and β-EP levels were significantly increased in group Y,yet decreased in group M in 3 and 10 min after intubation（ all P〈 0. 05）. Patients in group M had lower dose of muscle relaxant than those in group Y（ P〈 0. 05）. More number of muscle tremors and restlessness as well as sore throat and cough response were seen in group Y（ P〈 0. 05）. Patient in group M had better tolerance to tracheal intubation（ P〈 0. 05）. Conclusion： Slow analgesia induction with dexmedetomidine can be safe general anesthesia for elderly patients undergoing orthopedic surgery,and may lead to better postoperative awareness,fewer adverse effects and perfect analgesic effects.

关 键 词：右美托咪定 老年患者 慢诱导 气管插管 依托咪酯 

分 类 号：R614[医药卫生—麻醉学] R687.3[医药卫生—外科学]