不同剂量右美托咪定复合全凭静脉麻醉对老年高血压患者胸腔镜手术麻醉效果研究  

Anesthesia effect of different doses of dexmedetomidine combined with total intravenous anesthesia in elderly patients with hypertension undergoing thoracoscopic surgery

作　　者：刘春明 汪艳[2] 刘岩 董丽敏 李林 于晶 汪子仪 LIU Chun-ming;WANG Yan;LIU Yan;DONG Li-min;LI Lin;YU Jing;WANG Zi-yi(Department of Anesthesiology,Joint support force 961 hospital,Qiqihar 161000,China;Department of Medical Imaging,Peopled Hospital of Rizhao,Rizhao 276826,China;Department of Anesthesiology,Peopled Hospital of Rizhao,Rizhao 276826,China;Department of Anesthesiology,General Hospital of North Theater Command,Shenyang 110016,China)

机构地区：[1]联勤保障部队第九六一医院麻醉科,黑龙江齐齐哈尔161000 [2]日照市人民医院医学影像科,山东日照276826 [3]日照市人民医院麻醉科,山东日照276826 [4]北部战区总医院麻醉科,辽宁沈阳110016

出　　处：《临床军医杂志》2021年第8期861-865,共5页Clinical Journal of Medical Officers

基　　金：辽宁省重点研发指导计划(2019JH8/10300083)。

摘　　要：目的探讨不同剂量右美托咪定复合全凭静脉麻醉对老年高血压患者胸腔镜手术的麻醉效果。方法选取自2018年1月至2019年6月联勤保障部队961医院收治的90例需行胸腔镜的老年患者为研究对象。采用随机数字表法将其分为A组、B组、C组,每组各30例。A组、B组患者在麻醉诱导前15 min静脉滴注右美托咪定负荷剂量0.7μg/kg,分别在麻醉诱导行气管插管后开始静脉泵注右美托咪定0.3μg/(kg·h)、0.5μg/(kg·h)维持直到手术结束前半小时;C组患者给予等量的生理盐水静脉泵注。记录各组入室后输注右美托咪定前(T0)、麻醉诱导气管插管后即刻(T1)、首次单肺通气时(T2)、拔除气管导管后即刻(T3)的平均动脉压(MAP)、心率、肾上腺素、去甲肾上腺素、皮质醇。比较各组苏醒时间、拔管时间、躁动评分、镇静评分,以及不良反应发生情况。结果T1、T2、T3时A组、B组的MAP和心率均低于C组,差异有统计学意义(P<0.05)。A组T2、T3时的MAP、心率与B组比较,差异有统计学意义(P<0.05)。各组患者苏醒时间、拔管时间比较,差异无统计学意义(P>0.05)。C组躁动评分高于A组、B组,镇静评分低于A组、B组,差异有统计学意义(P<0.05)。B组躁动评分低于A组,镇静评分高于A组,差异有统计学意义(P<0.05)。A组、B组T1、T2、T3时肾上腺素、去甲肾上腺素、皮质醇低于C组,差异有统计学意义(P<0.05)。A组T2、T3时肾上腺素、去甲肾上腺素、皮质醇高于B组,差异有统计学意义(P<0.05)。C组不良反应发生率高于A组、B组,且A组高于B组,差异有统计学意义(P<0.05)。结论右美托咪定复合全凭静脉麻醉在老年高血压患者胸腔镜手术中,麻醉诱导前15 min静脉泵注负荷剂量0.7μg/kg,随后以0.5μg/(kg·h)维持麻醉,可有效地抑制气管插管和拔除气管导管时的应激反应,降低心脑血管并发症,加速患者术后康复。Objective To evaluate the anesthetic effect of different doses of dexmedetomidine combined with total intravenous anesthesia in elderly patients with hypertension undergoing thoracoscopic surgery.Methods A total of 90 elderly patients who required thoracoscopy were selected from January 2018 to June 2019.The patients were divided into group A,group B and group C with 30 patients in each group by random number table.Patients in group A and B were given a loading dose of 0.7μg/kg dexmedetomidine 15 minutes before anesthesia induction,after endotracheal intubation induced by anesthesia,dexmedetomidine[0.3μg/(kg·h)]and dexmedetomidine[0.5μg/(kg·h)]were respectively infused intravenously until half an hour before the end of operation.Patients in the control group C were treated with the same amount of normal saline intravenously.Mean arterial pressure(MAP),heart rate,epinephrine,norepinephrine,and cortisol were recorded in each group before infusion of dexmedetomidine(T0),immediately after tracheal intubation induced by anesthesia(T1),during the first one-lung ventilation(T2),and immediately after tracheal catheter removal(T3).The recovery time,extubation time,agitation score,sedation score,and the occurrence of adverse reactions were compared in each group.Results At T1,T2 and T3,MAP and heart rate in group A and B were lower than those in group C,with statistical significance(P<0.05).Compared with group B,there were statistically significant differences in MAP and heart rate at T2 and T3 in group A(P<0.05).There was no significant difference in recovery time and extubation time among all groups(P>0.05).The agitation score of group C was higher than that of group A and group B,and the sedation score was lower than that of group A and group B,the difference was statistically significant(P<0.05).The agitation score of group B was lower than that of group A,and the sedation score was higher than that of group A,with statistical significance(P<0.05).The levels of epinephrine,norepinephrine and cortisol in group A an

关 键 词：右美托咪定 全凭静脉麻醉 老年患者 高血压 胸腔镜手术 

分 类 号：R614[医药卫生—麻醉学]