老年围麻醉诱导期不同时机应用右美托咪定的对比研究

目的 分析围麻醉诱导期不同时机应用右美托咪定对老年患者血流动力学及麻醉效果的影响.方法 选取2012年5月～2014年5月浙江省宁波市鄞州人民医院收治老年肠胃手术患者120例作为研究对象,将其分Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组,各30例,分别以0.9％氯化钠溶液、诱导前右美托咪定、诱导时右美托咪定、诱导后右美托咪定进行处理.比较各组患者麻醉前（T0）、诱导前（T1）、插管前（T2）、插管后5 min （T3）、插管后10 min （T4）时,收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）值的变化.比较各组用药前、用药后5min、用药后10 rnin麻醉效果的RSS评分并统计分析各组患者麻醉过程中不良反应的发生情况.结果 四组患者T0时,SBP、DBP及MAP差异无统计学意义（P＞0.05）;T1、T2时SBP、DBP、MAP均有所下降（P＜0.05）,Ⅰ组下降幅度最大;T3、T4时四组SBP、DBP、MAP均上升（P＜0.05）,Ⅰ组上升幅度最大.Ⅱ、Ⅲ、Ⅳ组患者于应用右美托咪定后HR均明显下降（P＜0.05）,Ⅱ组的下降幅度最大.Ⅱ、Ⅲ、Ⅳ组用药后5 min、用药后10 min的RSS评分均明显高于Ⅰ组,而Ⅱ组的RSS评分明显高于Ⅲ、Ⅳ两组,上述差异均有统计学意义（均P＜0.05）.Ⅱ组患者不良事件发生率均低于其他三组,差异有统计学意义（P＜0.05）.结论 围麻醉诱导前应用右美托咪定辅助麻醉可有效稳定血流动力学,增加麻醉镇静深度并减少不良事件的发生率,值得在临床麻醉中进一步推广.

Comparative study of Dexmedetomidine application at the different time during anesthesia induction in elderly patients

Objective To analyze the influence of Dexmedetomidine application at the different time during anesthesia induction in elderly patients on haemodynamics and anesthetic effect. Methods 120 cases of patients with senile gas- trointestinal operation from May 2012 to May 2014 in Yinzhou People＇s Hospital of Ningbo City were selected, they were divided into group I , group Ⅱ, group HI, group IV, with 30 patients in each group, and 0.9% sodium chloride solution, before induction of Dexmedetomidine, induction of Dexmedetomidine, after induction of Dexmedetomidine were given respectively. The changes of SBP, DBP, MAP, HR in patients before anesthesia （To）, before induction （T1）, before intubation （T2）, 5 min after intubation （T3）, 10 min after intubation （T4） were compared. The RSS score of anes- thetic effects before medication, 5 min after medication, 10 min after medication were compared. The adverse reaction of patients were observed. Results At To, the differences of SBP, DBP and MAP in the four groups were not statistically significant （P 〉 0.05）; at %, T2, the SBP, DBP and MAP reduced （P 〈 0.05）, significantly in group I ; at T3, T4, the SBP, DBP and MAP increased （P 〈 0.05）, significantly in group I. After Dexmedetomidine application, HR signifi- cantly reduced in group Ⅱ, Ⅲ, IV （P 〈 0.05）, significantly in group Ⅱ. The RSS scores in group Ⅱ, Ⅲ, Ⅳ at 5 min after medication, 10 min after medication were higher than those in group I ; and the RSS score in group Ⅱ was high- er than those in group Ⅲ, IV, the differences were statistically significant （P 〈 0.05）. The incidence of adverse event in group Ⅱ was lower than the other three groups, the difference was statistically significant （P 〈 0.05）. Conclusion Dexmedetomidine application before induction can effectively stabilize hemodynamics, increase the depth of sedation and reduce the incidence of adverse events. It is worthy of popularizing in clinical anesthesia.