右美托咪定对全麻老年患者拔管期的影响

目的探讨手术结束前给予右旋美托咪定对老年人全身麻醉苏醒拔管期的影响。方法将40例择期行股骨骨折切开复位内固定术患者随机分为右旋美托咪定组（D组）、对照组（C组）各20例。两组患者术中全麻诱导和维持相同,手术结束前10minD组患者于10min内静脉泵注0.5μg/kg的右美托咪定,C组患者以相同速率静脉泵注相同容量生理盐水。观察并记录术毕（T1）、术后15min（T2）、拔管时（T3）、出恢复室时（T4）收缩压（SBP）、舒张压（DBP）、心率（HR）、脉搏血氧饱和度（SpO2）、呼气末二氧化碳分压（PETCO2）、拔管时间以及Ramsay评分、VAS评分、躁动评分。结果 D组拔管时血压,心率略升,较手术结束时无明显差异,其他各时间段内的变化无统计学差异（P〉0.05）。C组T2、T3、T4较T1血压、心率升高明显（P〈0.05）。两组T2、T3、T4各个时间段血压,心率差异有统计学意义（P〈0.05）,两组T1、T2、T3、T4SpO2,T1、T2、T3PETCO2无统计学差异（P〉0.05）。两组T2、T3、T4Ramsay评分、躁动评分差异有统计学意义（P〈0.05）,T4VAS评分差异有统计学意义（P〈0.05）。结论右美托咪定在老年人苏醒拔管期予镇静的同时保持孩子可以被唤醒,兼有镇痛作用,能有效降低老年患者拔管期的心血管反应,无呼吸抑制作用。

Effect of Dexmedetomidine on Clinical Profiles in elderly Patients in the Period of Tracheal Extubation

Objective To determine the effect of administration of dexmedetomidine by the end of operation on clinical profiles in the period of tracheal extubation in general anesthesia elderly patients. Methods 40 elderly patients who were undergoing Femoral fractures surgery with open rvductinn and internal fixation were randomly divided into dexmedetomidine group（group D） or control group（group C）. The scheme of induction and maintenance of anesthesia of the two groups were identical. Patients in group D were administered dexmedetomidine at a dose of 0.5pg/kg over 10~fin and in group C patients were given a placebo infusion of normal saline at identical rates at 10rain by the end of the operation. Systolic blood pressure（SBP）, diastolic blood pressure（DBP）, heart rate（HR）, pulse oxygen saturation（SpO2）, end-tidal carbon dioxide pressure（PETCO2）, extubatien time and Ramsay score, VAS score, Agitation score were recorded at ending operation（T1）, 15min after the operation（Tz）, extubation（T3）, leaving the PACU（T4）. Remflts SBP, DBP, HR in group D were no significantly different at TI,T2,T3 and T4（P〉0.05）. SBP, DBP, HR in group C were significantly different at T1,T2,T3 and T4（P〈0.05）. SBP, DBP, HR in group D during peri-extubation were significantly different from those in group C which fluctuated more inarkedly（P〈0.05）. SpO2 and PETCO2 in group D during peri-extubation were no significantly different from those in group C（P〉0.05）. Tolerance score to endotracheal tube in group D was superior to that in group C（P〈0.05）. Conclusions Dexmedetomidine could effectively reduce the cardiovascnalar response to, together with retaining the awakened power of patients under active sedation. It＇s analgesic effect is strong but without respiratory depression.