右美托嘧啶持续输注用于老年脊柱手术麻醉中的临床观察

目的 探讨右美托嘧啶持续输注对老年患者麻醉中血流动力学、麻醉药物用量及术后苏醒的影响.方法 50例择期老年脊柱手术患者按随机数字表法随机分为右美托嘧啶组（D组）和对照组（C组）,每组各25例.麻醉诱导前D组患者10min内静脉泵入0.5μg/kg右美托嘧啶,C组泵入等量生理盐水.然后行麻醉诱导气管内插管,同时以0.4μg/（kg·h）速度持续泵注右美托嘧啶至手术结束.术中以丙泊酚和瑞芬太尼持续输注维持麻醉,维持术中脑电双频谱指数（BIS）为40 ～60.记录患者血流动力学变化,手术时间,麻醉药物用量及苏醒时间.结果 输注右美托嘧啶5min时,D组平均动脉压较C组升高;8min及10min时心率、平均动脉压及BIS值较C组降低.插管时两组血压、心率均有升高,但C组血压、心率升高较D组有统计学差异.两组手术时间、术中血压、心率变化无统计学差异,拔管时C组血压、心率升高较D组有统计学差异.术中丙泊酚及瑞芬太尼用量D组明显少于C组.苏醒期D组BIS值恢复至60、70、80及睁眼时间较C组明显延长.结论 右美托嘧啶持续输注用于老年患者脊柱手术的麻醉,有利于维护老年患者血流动力学的稳定,减少丙泊酚和瑞芬太尼的用量,但延长患者术后苏醒时间.

Efficacy of Continuous Infusion of Dexmedetomidine for Aged Patients During Spine Sugery

Objective To evaluate the perioperative effect of intraoperative infusion of dexmedetomidine in aged patients undergoing spine surgery under total intravenous anesthesia.Methods Fifty patients （aged 65-85years） scheduled for elective spine surgery were randomly allocated to dexmedetomidine group （group D,n =25 per group） or control group （group C）.Placebo or dexmedetomide 0.5μg/kg was given as a bolus dose 10 minutes before induction,followed by a maintenance infusion of 0.4μg/（kg · h） until the end of surgery.Propofol and remifentanil were pumped intravenously to maintain the Bispectral index （BIS） 40-60.Haemodynamic changes,time of surgery,anesthetic requirements and recovery time were recorded.Results During the bolus dose infused time,compared to group C,MAP incraesed in group D at 5 minutes,however MAP,HR and BIS value decreased at 8 or 10 minutes.Though MAP and HR increased in the two groups at the time of intubation and extubation,group C got a higher MAP and HR compared to group D.The operation time,MAP and HR during the operation had no significant difference.Group D required less propofol and remifentanil throughout the operation.The time to eye opening of group D was much longer than that of group C.Conclusion Continuous infusion of dexmedetomidine for aged patients maintains the haemodynamic stability,reduces the anesthetics requirement and prolongs the recovery time.