右美托咪定对老年高血压患者全麻拔管期应激反应及苏醒时间的影响

目的研究仅2肾上腺素受体激动剂右美托咪定在全麻拔管期间对老年高血压患者的应激反应及苏醒时间的影响。方法选择40例Ⅰ～Ⅱ期原发性高血压行择期手术的患者，年龄60～76岁，ASAⅠ～Ⅱ级，采用随机数字表分为右美组（D组）和对照组（C组），各20例。采用静吸复合全麻，手术结束前30min，D组泵注右美托咪定0．5μg/kg，泵注时间为15rain。C组给予等量0．9％氯化钠溶液。观察用药前（TO）、拔管前即刻（T1）、拔管后即刻（T2）、拔管后3min（T3）、拔管后5min（T4）心率（HR）、平均动脉压（MAP）、肾上腺素（E）和去甲肾上腺素（NE）浓度的变化；记录术毕自主呼吸恢复时间、唤醒时间、清醒拔管时间。结果C组T1～T4时间点的HR、MAP较11D时HR和MAP升高（P〈0．05或〈0．01）；D组T2和乃时HR，MAP较T0时HR和MAP升高（均P〈0．05），但升高的幅度明显小于C组（均P〈0．01）；D组T1～T4时间点的血浆E浓度，NE浓度均较rm时E和NE升高（P〈0．05或P〈0．01），但升高的幅度明显小于C组（均P〈0．01）；两组患者自主呼吸恢复时间、唤醒时间、清醒拔管时间比较差异无统计学意义（P均〉0．05）。结论术毕前0．5ug／kg右美托咪定可抑制老年高血压患者全麻拔管期的应激反应，促进血流动力学的稳定，且不延长呼吸恢复时间、唤醒时间和清醒拔管时间。

Effects of dexmedetomidine on stress reaction and recovery time during tracheal extubation in old patients with hypertension

Abstract：Objective To explore the effects of dexmedetomidine（DEX） on stress reaction and recovery time during tra- cheal extubation in the elderly patients with hypertension. Methods Forty patients with primary hypertension ofⅠ to Ⅱ degree, aged 60 to 76, American Society of Anesthesiology Ⅰ and Ⅱ , scheduled for selective operation, were recruited in this study. The subjects were randomly assigned into dexmedetomidine group （ Group D） and control group （ Group C ） with 20 cases in each group to receive intravenous plus inhalation anesthesia. At 30 minutes prior to the end of surgery, patients in the dexmedetomidine group were subject to intravenous 0.5 ~g/kg dexmedetomidine via micropumps for 15 minutes, while the control group received intravenous normal saline via micropumps. Heart rate （ HR）, mean artery blood pressure（MAP） ,SpO2 ,epinephrine（E） and norepinephrine（NE） in both groups were recorded before the DEX applica- tion（ TO ） , immediately before extubation（ T1 ）, immediately after extubatiou（ T2 ） , 3 rain （T3） and 5 rain after extubation （ T4 ） , respectively. Recovery time of autonomous respiratory, wake-up time and extubation time on consciousness were al- so documented. Results In group C, HR were significant higher at time of T1 - T4 compared to TO （ P 〈 0.01 ） , MAP were significant higher at time of T1 - T4 compared to TO （ P 〈 0.05 or P 〈 0.01 ） ; In group D, HR at time of T2 and T3, MAP at time of T2 and T3 were higher compared to TO （ P 〈 0.05 ）, but MAP and HR were significantly lower than group C （ P 〈 0.01 ） ; In group C, E were significant higher at time of T1 - T4 compared to TO （ P 〈 0.05 or P 〈 0.01 ）, NE were significant higher at time of T1 -T4 compared to TO （P 〈 0.01 ）, In group D, E were significant higher at time of T1 -T4 compared to TO（P 〈0.05 or P 〈0.01 ） ,NE were significant higher at time of T1 - T4 compared to TO（P 〈0.05 or P 〈 0.01 ） , but E and NE were significantly lower than group C （ P 〈 0.01 ） ; There was no significant difference in recovery time of autonomous respiratory, wake-up time and extubation time on consciousness （ P 〉 0.05 ）. Conclusion Dexmedeto- midine before the end of surgery can inhibit stress response and stability hemodynamic during extubation for the elderly patients with hypertension, and not prolong the breathing recovery time, wake-up time and extubation time.