右美托咪定对老年患者气管插管循环系统的影响

目的 研究不同剂量右美托咪定（Dex）对老年患者气管插管血流动力学的影响.方法 择期气管内插管全身麻醉行腹部外科手术老年患者80例,每组20例,将其分成N组（0.9%NS）、L组（Dex 0.25 μg·kg-1）、M 组（Dex 0.5 μg·kg-1）、H组（Dex 1.0 μg·kg-1）.麻醉诱导前静脉泵注0.9%NS或用0.9%NS稀释成4 mg·L-1的Dex,各组均输注15 min.记录入室后基础值（T0）、全麻诱导前（T1）、插管前（T2）、插管后即刻（T3）,插管后3 min（T4）各时点的HR、MAP、ECG变化.结果 T1,与N组相比较,三组输注Dex后L、M和H组患者HR 、MAP均下降（P〈0.05）.T2,L组、M组、H组患者的HR、MAP均降低（与N组比较,P〈0.05）.T2,H组4例窦性心动过缓,5例低血压;M组出现2例窦性心动过缓.T3,三组患者HR、MAP有不同程度上升;N组HR、MAP与M、L组相比,明显上升（P〈0.05）.T4,H组HR、MAP与 N组比较降低（P〈0.05）,H组出现4例窦性心动过缓.结论 老年患者术前输注0.5 μg·kg-1右美托咪定15 min可减少气管插管血流动力学变化,可能更适合老年患者.

Effects of different target concentrations of dexmedetomidine on the hemodynamic response to the elderly patients tracheal intubation during induction of general anestbesia

Objective To study the effect of different doses of dexmdetomidine on hemodynamics of elderly patients with endotracheal in- tubation. Methods Eighty elderly patients were randomized into four groups with 20 cases each. Each group received a dexmedetomidine target concentration （STC） of 0.25 μg · kg^ -1 （L） ,0.5μg · kg^ -1 （ M）, 1.0μg · kg^ -1（H） or normal saline（N） ,respectively within 50 mL saline at 15 min. Mean arterial pressure （ MAP）, heart rate （ HR）, and ECG were recorded at the time points of record baseline （ T0 ）, before induction （ Ta ）, before tracheal intubation （ T2 ） , immediately after intubation （ T3 ）, after intubation 3min （ T4 ）. Results T4 time, HR and MAP of three groups were significantly decreased, compared with.N group after intravenuous injection dexmedetomidine （ P 〈 0.05 ）, T2 time, comparision with N, three groups also decreased （ P 〈 0.05 ）. Four cases of sinus bradycardia （ HR 〈 60 beats per minute） and five cases of low blood tension （ SBP decreased over 30% ） were in group H. Two cases of sinus bradycardia in group M. T3 , HR, MAP of group M and H Were decreased, compared with N （P 〈 0.05 ）. T4, compared with N, H group was decreased （P 〈 0.05 ）, Four cases of sinus bradycardia. Conclusion Perfusion of dexmedetomine before induction could induce to less variation in hemodynam- ics during intubation in patients with hypertension. It could be better option for the dose of dexmedetomidine 0.5 μg · kg^ -1lasting 15 min. Key words： dexmdetomidine ; elderly; endotracheal intubation; hemodynamics