右美托咪啶对老年患者骨科手术后恢复的影响

目的 观察右美托咪啶（dexmedetomidine,DEX）对老年患者骨科手术后恢复以及麻醉并发症的影响.方法 选择65岁以上全身麻醉下实施骨科手术的患者40例ASAⅠ-Ⅱ级,随机分为DEX组和对照组,每组20例.DEX组患者术前10 min泵注0.5 μg·kg-1·h^-1DEX,对照组患者给予相同剂量生理盐水,2组均常规诱导插管.术中DEX组持续静脉泵注DEX 0.4 μg·kg-1·h^-1,2组均采用静脉复合维持麻醉.观察停止麻醉后患者的苏醒时间和拔管时间,记录手术前（T1）、入恢复室时（T2）、苏醒时（T3）及拔管时（T4）时患者的血压（BP）、心率（HR）、脉搏氧饱和度（SpO2）,并记录有无恶心呕吐及寒战的发生.结果 DEX组较对照组苏醒时间和拔管时间延长（P〈0.05）;麻醉恢复期对照组恶心呕吐及寒战的发生率高于DEX组（P〈0.05）;拔管时DEX组血流动力学较对照组平稳.结论 右美托咪啶麻醉诱导及维持会延长老年患者术后苏醒时间和拔管时间,但可以维持血流动力学平稳并降低恢复期恶心呕吐及寒战的发生率.

Effect of dexmedetomidine on the quality of anesthesia recovery in aged patients after orthopedics operation

Objective To observe the effect of dexmedetomidine （DEX） on the quality of anesthesia recovery and anesthetic complications in aged patients after orthopedics operation. Methods 40 American Society of Anesthesiologists （ASA） Ⅰ or Ⅱ patients were randomly assigned to 2 groups. Group D received DEX 0.5 μg·kg^-1·h^-1 in 10 rain as bolus be-lore induction and 0.4 μg·kg^-1·h^-1 during the operation by infusion. Group C received equal volume of normal saline as group D intravenously without DEX. All other induction and maintenance drugs were the same in both groups. All pa-tients were sent to post anesthesia care unit （PACU） after operation. The extubation time, palinesthesia time and heart rate （HR） , mean arterial pressure （MAP） , and SpO2 before anesthesia （ T1 ） , arrived at PACU （ T2 ） , anesthesia re- covery （ T3 ） , and extubation （ T4 ） were recorded. The number of patients who had nausea and vomiting or shivering dur-ing anesthesia recovei7 were also recorded. Results Extubation and postanesthesia time of patients in group D were lon-ger than patients in group C （ P 〈 0.05 ）. The number of patients who had nausea and vomiting or shivering were signifi- cantly higher in group C compared with group D （ P 〈 0.05 ）. The hemodynamics at extubation were stable in group D compared with group C. Conclusions DEX can prolong the time of anesthesia recovery and extubation in aged patients, at the same time it can maintain the hemodynamics stable and decrease the incidence of nausea and vomiting or shivering （luring anaesthesia recovery.