经食管超声评价右美托咪定对不同年龄段腹腔镜胆囊切除全身麻醉患者心输出量的影响

目的通过经食管超声心动图（TEE）评估右美托咪定（Dex）对不同年龄段腹腔镜胆囊切除全身麻醉患者的心输出量和心血管反应的影响。 方法选取2017年6月至2019年6月安徽医科大学附属省立医院收治的全身麻醉行腹腔镜胆囊切除手术患者120例，按照年龄段分为青年组（20~39岁）37例、中年组（40~59岁）41例、老年组（≥60岁）42例。所有患者从麻醉诱导后血流动力学平稳时开始给予Dex。行TEE检查测定麻醉诱导后泵注Dex前（T₀）、麻醉诱导后泵注Dex 10 min（T₁）、30 min（T₂）、60 min（T₃）的心率、平均动脉压（MAP）、血氧饱和度（SpO₂）、血流速度时间积分（VTI）、每搏输出量（SV）、心输出量以及视觉模拟评分法（VAS）镇痛评分、Ramsay镇静评分。分别于各时间点测定血浆皮质醇、血糖和肾上腺素。记录患者心血管不良反应以及躁动发生情况。青年组、中年组和老年组比较采用单因素方差分析和重复测量设计的方差分析，3组间两两比较采用配对t检验或χ²检验。 结果青年组和中年组T₃的心率、MAP、SV，T₂、T₃的心输出量均低于同组的T₀，差异均具有统计学意义（P均＜0.05）。老年组T₁、T₂、T₃的心率、MAP、SV，T₂、T₃的心输出量均低于T₀，差异均具有统计学意义（P均＜0.05）。老年组T₂、T₃的心率、MAP、SV、心输出量均低于同时间点的青年组和中年组，差异具有统计学意义（P均＜0.05）；青年组和中年组T₃的血浆皮质醇、血糖，T₂、T₃的血浆肾上腺素均高于同组的T₀，差异均具有统计学意义（P均＜0.05）。老年组T₂、T₃的血浆皮质醇、血糖，T₁、T₂、T₃的血浆肾上腺素均高于同组的T₀，差异具有统计学意义（P均＜0.05）。老年组T₃的血浆皮质醇，T₂、T₃的血浆血糖，T₁、T₂、T₃的血浆肾上腺素均高于同时间点的青年组和中年组，差异具有统计学意义（P均＜0.05）；青年组、中年组和老年组患者T₁、T₂、T₃的VAS镇痛评分均低于同组T₀，Ramsay镇静评分均高于同组T₀，差异均具有统计学意义（P均＜0.05），组间比较差异均无统计学意义（P均＞0.05）；老年组患者发生低血压、心动过缓比例高于青年组和中年组（老年组vs青年组vs中年组：5 vs 0 vs 0、7 vs 0 vs 1），差异具有统计学意义（低血压：χ²=4.702、5.194，P=0.030、0.023；心动过缓：χ²=6.766、4.822，P=0.009、0.028）。 结论相同剂量的Dex对不同年龄全身麻醉患者的心血管反应有明显差异，对老年患者的血流动力学和心输出量影响更为明显，发生低血压、心动过缓等心血管不良反应的概率更高。

Transesophageal ultrasound for evaluation of effect of dexmedetomidine on cardiac output in patients with laparoscopic cholecystectomy under general anesthesia at different ages

Objective To evaluate the value of ransesophageal echocardiography(TEE)in evaluating the effect of dexmedetomidine(Dex)on cardiac output and cardiovascular response in patients with laparoscopic cholecystectomy under general anesthesia at different age groups.Methods A total of120 patients undergoing laparoscopic cholecystectomy under general anesthesia at our hospital from June2017 to June 2019 were selected,and according to age,they were divided into a youth group(20-39 years old,37 patients),middle-aged group(40-59 years old,41 patients),and elderly group(≥60 years old,42 patients).All patients were given Dex when hemodynamics stabilized after induction of anesthesia.Before Dex injection after induction of anesthesia(T₀)and at Dex injection for 10 min(T₁),30 min,and Dex injection for 60 min(T₃)after induction of anesthesia,TEE was used to measure patients’heart rate,mean arterial pressure(MAP),blood oxygen saturation(SpO2),velocity time integral(VTI),stroke volume(SV),cardiac output,visual analog scale(VAS)score,and Ramsay sedation score.Plasma cortisol and blood sugar and epinephrine at each time point were measured.Cardiovascular adverse reactions and the occurrence of agitation were recorded.The paired t-test or chi square test was used for between-group comparisons,and one-way ANOVA and repeated measures ANOVA were used for comparisons among three groups.Results The heart rate,MAP,and SV at T₃ and the cardiac output at T₂ and T₃ were significantly lower than those at T₀ in the youth group and middle-aged group(P<0.05).The heart rate,MAP,and SV at T₁,T₂,and T₃ and the cardiac output at T₂ and T3 were significantly lower than those at T₀ in the elderly group(P<0.05).The heart rate,MAP,SV,and cardiac output at T₂ and T₃ in the elderly group were significantly lower than those of the youth group and middle-aged group at the same time points(P<0.05).Plasma cortisol and blood sugar at T₃ and plasma epinephrine at T₂ and T₃ were significantly higher than those at T₀ in the youth group and middle-aged group(P<0.05).Plasma cortisol and blood sugar at T₂ and T₃ and plasma epinephrine at T₁,T₂,and T₃ were significantly higher than those at T₀ in the elderly group(P<0.05).Plasma cortisol at T₃,blood sugar at T₂ and T3,and plasma epinephrine at T₁,T₂,and T₃ in the elderly group were all significantly higher than those of the young and middle-aged groups at the same time points(P<0.05).The VAS scores and Ramsay sedation scores at T₁,T₂,and T₃ in the young,middle-aged,and elderly groups were all significantly lower than those at T₀(P<0.05).There was no statistically significant difference in the scores between the groups(P>0.05).The incidence of hypotension and bradycardia in the elderly group was significantly higher than that in the young group and middle-aged group(χ²=4.702,5.194,6.766,and 4.822,P=0.030,0.023,0.009,and0.028,respectively).Conclusion Dex at the same dose has significantly different cardiovascular response in general anesthesia patients of different ages,and it has a more obvious impact on the hemodynamics and cardiac output of elderly patients.Elderly patients are more likely to have cardiovascular adverse reactions such as hypotension and bradycardia.