盐酸右美托咪定对老年椎管内麻醉手术患者术中应激反应及术后躁动的影响  

Effect of dexmedetomidine hydrochloride on intraoperative stress response and postoperative agitation in elderly patients undergoing spinal anesthesia operation

作　　者：陈巧玲[1] 俞高洁 陈曲敏[1] CHEN Qiaoling;YU Gaojie;CHEN Qumin(Department of Anesthesiology and Surgery,First Affiliated Hospital of Xiamen University,Fujian,Xiamen,361003,China)

机构地区：[1]福建省厦门大学附属第一医院麻醉手术科,福建厦门361003

出　　处：《当代医学》2023年第33期50-54,共5页Contemporary Medicine

摘　　要：目的探究盐酸右美托咪定对老年椎管内麻醉手术患者术中应激反应及术后躁动的影响。方法选取2019年1月至2021年1月福建省厦门大学附属第一医院接诊且行椎管内麻醉手术的80例老年患者作为研究对象,随机分为观察组(右美托咪定)与对照组(0.9%氯化钠溶液),每组40例。比较两组不同时点应激反应指标[皮质醇(Cor)、去甲肾上腺素(NE)]、血流动力学指标[心率(HR)、平均动脉压(MAP)]、T细胞亚群(CD8^(+)、CD4^(+)、CD4^(+)/CD8^(+))及术后躁动情况、不良反应发生情况。结果给药前(T1)、给药30 min(T4),两组Cor、NE水平比较差异无统计学意义;给药60 min(T5)、术毕(T6)时,观察组Cor、NE水平均低于对照组,差异有统计学意义(P<0.05)。T1、给药10 min(T2)、给药20 min(T3)及T4时,两组HR比较差异无统计学意义;T5、T6时,观察组HR低于对照组(P<0.05)。T6时,两组CD8^(+)、CD4^(+)水平及CD4^(+)/CD8^(+)均低于T1时,但观察组CD8^(+)、CD4^(+)水平均高于对照组,CD4^(+)/CD8^(+)低于对照组,差异有统计学意义(P<0.05)。观察组术后躁动发生率为7.50%,低于对照组的35.00%,差异有统计学意义(P<0.05)。观察组呼吸抑制、呕吐、恶心、心动过缓发生率均低于对照组,差异有统计学意义(P<0.05)。结论盐酸右美托咪定应用于老年椎管内麻醉手术可减轻患者应激反应,稳定血流动力学,缓解对免疫功能的不良影响,且不易出现躁动及不良反应,值得临床推广应用。Objective To explore the effect of dexmedetomidine hydrochloride on intraoperative stress response and postoperative agitation in elderly patients undergoing spinal anesthesia operation.Methods A total of 80 elderly patients who undergoing spinal anesthesia in the First Affiliated Hospital of Xiamen University from January 2019 to January 2021 were selected as the research subjects,they were randomly divided into the observation group(dexmedetomidine)and the control group(0.9%sodium chloride solution),with 40 cases in each group.The stress response indexes(cortisol[Cor],norepinephrine[NE]),hemodynamic indexes(heart rate[HR],mean arterial pressure[MAP]),T cell subsets(CD8^(+),CD4^(+),CD4^(+)/CD8^(+))at different time points,postoperative agitation and adverse reactions were compared between the two groups.Results Before administration(T1)and 30 min after administration(T4),there was no significant difference in Cor and NE levels between the two groups;at 60 min after administration(T5)and at the end of operation(T6),the levels of Cor and NE in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).At T1,10 min(T2),20 min(T3)and T4,there were no significant differences in HR between the two groups;at T5 and T6,the HR in the observation group was lower than that in the control group.At T1,there was no significant difference in MAP between the two groups;at T2-T6,the MAP in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).At T6,the levels of CD8^(+),CD4^(+)and CD4^(+)/CD8^(+)of the two groups were lower than those at T1,and CD4^(+)/CD8^(+)in the observation group was lower than that in the control group,but the levels of CD8^(+)and CD4^(+)in the observation group were higher than those in the control group,the differences were statistically significant(P<0.05).The incidence of postoperative agitation in the observation group was 7.50%,which was lower than 35.00%in the control gro

关 键 词：盐酸右美托咪定 老年 椎管内麻醉 应激反应 术后躁动 

分 类 号：R614[医药卫生—麻醉学]