老年高血压患者诱导前予右美托咪啶对插管期血流动力学的影响

目的观察右美托咪啶预注对老年高血压，尤其是未控制的老年高血压患者的全麻诱导期气管插管时血流动力学改变的影响。方法：选择未控制和控制良好拟在全麻下行择期手术的老年高血压患者各40例，ASA均为Ⅱ级。分为4组：D1组（血压控制良好组，术前规则服用降压药，血压维持在140—160／80—90mmHg，麻醉诱导前静脉滴注右美托咪啶0．7gg／kg，输注时间10min），D2组（入院后方诊断为高血压，收缩压〉160mg，麻醉诱导前静脉滴注右美托咪啶0．7gg／kg，输注时间10min），C1组（入选标准同D1，麻醉诱导前静脉滴注等量生理盐水）和C2组（入选标准同D：组，麻醉诱导前静脉滴注等量生理盐水），每组各20例。分别记录人室（T0）、用药前（T1）、全麻诱导前（T2）、气管插管前（T2）、插管后即刻（T4）、插管后5min（T5）患者的肱动脉收缩压（SAP）、舒张压（DAP）、心率（HR）和脉搏血氧饱和度（SpO2）。结果：各组基本信息无统计学差异。各组在T0和T1时间点，各观察指标亦无差异俨〉O．05）。与T0相比，右美托咪啶组（Dl和D2）在T2和T3时间点SAP和HR降低（P〈0．05），插管后（T4）血流动力学基本没有变化；C1和C2组插管后（T4），SAP、DAP和HR较插管前（T3）上升（P〈0．05）。结论全麻诱导前静脉预注右美托咪啶，不仅能使血压控制良好的老年高血压患者全麻诱导及气管插管期间的血流动力学维持稳定，对血压未经控制的老年高血压患者同样安全有效，且有利于对老年高血压患者更好地进行围术期血流动力学管理。

Effects of Dexmedetomidine on cardio-vascular responses to tracheal intubation in the elderly with controlled or uncontrolled hypertension

Objective To investigate the effects of dexmedetomidine on cardio-vascular responses to tracheal intubation in eged with hypertension, especially the uncontrolled ones. Methods 80 caces scheduled for elective surgeries were divided into four equal-sized groups. Group D,： well-controlled hypertensive patients with blood pressure （ BP ） maintained at 140-160/80-90mmHg, received intravenous （iv） injection of0.7~g/kg dexmedetomidine in 10 minutes before anesthesia induction. Group D2： newly diagnosed hypertension after hospitalization with systolic BP 〉 160mmHg, received iv injection of0.71.g/kgdexmedetomidineinl0minutesbeforeanesthesiainduction. GroupCl： control for well-controlled hypertensive patients as Group D1, received the same volume of saline before anesthesia induction. Group C2： Patients newly diagnosed hypertension after hospitalization with systolic BP 〉 160 mmHg as in Group D2, received the same volume of saline before anesthesia induction. Systolic pressure （SAP）, diastolic pressure （DAP）, heart rate （HR） and pulseoxygensaturation （SpO2） were recorded respectively at different time points including entering the operating room （T0）, before dexmedeto- midine usage （T1）, before induction （T2）, before intubation （T3）, during intubation （T4） and 5 minutes after intubation （T5）. Results There were no significant differences in baseline characteristics among groups. Compared with To, SAP and HR in DI and D2 groups were all decreased at T2and T3 （P〈0.05）, while SAP and HR were not changed obviously after tracheal intubation （T4）. SAP and HR in C1 and C2 groups were increased significantly （P〈0.05） at T4 compared withT3 （P〈0.05）. Condusion Intravenous injection of Dexmedetomidine before anesthesia induction effectively maintains haemodynamic stable during induction and tracheal intubation in geriatric hypertensive patients. Importantly, administration of dexmedetomidine provides significant benefits for the perioperative haemodynamic management of patients with hypertension.