右美托咪啶对老年颅脑手术患者血流动力学及应激反应的影响

目的探讨右美托咪啶对老年颅脑手术患者术中血流动力学及唤醒试验中应激反应的影响。方法抽取2013-10—2016-11焦作市人民医院行颅脑手术98例老年患者,按照随机数表法分为2组各49例。观察组麻醉诱导前10min静脉输注0.8μg/kg右美托咪啶,后以0.4μg/(kg·h)速度维持,唤醒试验前30min将右美托咪啶输注速度调整至0.1μg/(kg·h),对照组以等量生理盐水代替。记录2组术中不同时段[T1(唤醒前30min)、T2(唤醒即刻)、T3(唤醒后5min)、T4(试验结束后加深麻醉10min)]血流动力学指标[心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心脏排血指数(CI)]水平及唤醒前瑞芬太尼、丙泊酚、顺阿曲库铵用量与唤醒时间,并统计2组唤醒期间高血压、心动过速、躁动、呛咳不良反应发生率。结果 2组各个时段CVP及T1、T4时段MAP、CI水平差异无统计学意义(P0.05),观察组各个时段HR及T2、T3时段MAP水平均低于对照组,T2、T3时段CI高于对照组,差异有统计学意义(P0.05);2组唤醒试验前顺阿曲库铵用量及唤醒时间比较差异无统计学意义(P0.05),观察组唤醒前瑞芬太尼及丙泊酚用量少于对照组,差异有统计学意义(P0.05);观察组唤醒试验中高血压、心动过速、躁动发生率均低于对照组,差异有统计学意义(P0.05),呛咳发生率与对照组比较差异无统计学意义(P0.05)。结论右美托咪啶用于老年颅脑手术中,有利于维持患者术中血流动力学稳定,减少麻醉药物使用剂量,进而可有效降低唤醒试验中应激反应发生率。

Effects of dexmedetomidine on intraoperative hemodynamics and wake-up test stress response in elderly patients undergoing brain surgery

Objective To investigate the effect of dexmedetomidine on intraoperative hemodynamics and wake-up test stress response in elderly patients undergoing brain surgery.Methods From October 2013 to November 2016,98 elderly patients subjec-ted to craniocerebral surgery in the People's Hospital of Jiaozuo were randomly divided into observation group (n =49)and control group (n =49).For the observation group,intravenous infusion 0.8 μg/kg of dexmedetomidine at 10 min before anesthesia induc-tion and maintained at a rate of 0.4 μg/(kg·h).30 min before awakening,the infusion rate of dexmedetomidine was adjusted to 0.1 μg/(kg·h);the control group was replaced with same amount of normal saline.Intraoperative different periods (T1 (30 min before wake-up),T2 (wake-up),T3 (5 min after wake-up)and T4 (anesthesia for 10 min after the end of the trial)),hemodynamics (heart rate (HR),mean arterial blood pressure (MAP),central venous pressure (CVP)and cardiac ejection index (CI))levels and pre-awakening remifentanil,propofol,cisatracurium dosage and wake-up time of the two groups were recorded,besides,hyperten-sion,tachycardia,restlessness and cough incidence were analyzed as well.Results There was no significant difference in the CVP at different time points and T1 and T4 MAP and CI levels between the two groups at different time points (P >0.05),each time point MAP and T2 ,T3 MAP levels in the observation group were lower than those in the control group,but T2 ,T3 CI levels were higher than those in the control group,the difference was statistically significant (P <0.05);there was no significant difference in the cisatracurium dosage before awakening test and awakening time between the two groups (P > 0.05 ),before awakening,the remifentanil and propofol dosage in the observation group was significantly lower than that in the control group (P <0.05 );the wake-up test hypertension,tachycardia and restlessness incidence in the observation group was significantly lower than that in the control group (P <0.05),there was no significant difference in the choking incidence between the two groups (P >0.05).Conclu-sion Elderly brain surgery using dexmedetomidine can improve hemodynamic stability,reduce narcotic drugs dose,and it can fur-ther effectively reduce stress reaction incidence in the wake-up test.