右美托咪定对高血压病患者腰硬联合麻醉的镇静效应及血流动力学的影响

目的观察右美托咪定对高血压病患者腰硬联合麻醉的镇静效应及血流动力学的影响。方法将60例拟行腰硬联合麻醉的高血压病患者分为对照组、右美托咪定组和丙泊酚组,每组20例。记录麻醉前(T0)、腰硬联合麻醉开始后(T1)及用药后5(T2)、15(T3)、30(T4)、60 min(T5)时警觉/镇静(OAA/S)评分及收缩压(SBP)、舒张压(DBP)、心率(HR)、呼吸率(RR)和动脉血氧饱和度(SpO2)。结果 T0、T1时3组OAA/S评分比较差异无统计学意义(P>0.05);对照组各时点OAA/S评分比较差异无统计学意义(P>0.05)。T2～T5时右美托咪定组和丙泊酚组OAA/S评分显著低于T0时(P<0.05),右美托咪定组T3～T5时及丙泊酚组T2～T5时OAA/S评分显著低于对照组(P<0.05)。3组患者T0和T1时SBP、DBP、HR、RR及SpO2比较差异均无统计学意义(P>0.05)。丙泊酚组T3～T5时SBP和HR及T4～T5时DBP和RR显著低于T0时(P<0.05)。右美托咪定组T3～T5时HR显著低于T0时(P<0.05)。丙泊酚组T5时HR及T4～T5时RR显著低于对照组(P<0.05),T4～T5时丙泊酚组SBP显著低于对照组和右美托咪定组(P<0.05)。结论高血压病患者腰硬联合麻醉期间应用右美托咪定可获得满意的镇静效果,并能保持血流动力学平稳。

Effects of dexmedetomidine on sedation and hemodynamics in patients with hypertension during combined spinal epidural anesthesia

Objective To observe the effects of dexmedetomidine on sedation and hemodynamics in patients with hypertension during combined spinal epidural anesthesia.Methods Sixty patients with hypertension were divided into control group,dexmedetomidine group and propofol group,twenty cases in each group.The observer assessment of alertness/sedation(OAA/S) scores and systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR),respiration rate(RR),pulse oxygen saturation(SpO2) were recorded before anesthesia(T0) and 0(T1),5(T2),15(T3),30(T4) and 60 minutes(T5) after sedative administration.Results There was no statistical difference in the OAA/S score among three groups at T0-T1(P>0.05).There was no statistical difference in the OAA/S score among T0-T5 in control group(P>0.05).The OAA/S scores in dexmedetomidine group and propofol group were lower at T2-T5 than those at T0(P<0.05).OAA/S scores were lower in dexmedetomidine group at T3-T5 and in propofol group at T2-T5 than those in control group(P<0.05).There was no statistical difference in SBP,DBP,HR,RR and SpO2 among three groups at T0-T1(P>0.05).In propofol group,SBP and HR at T3-T5 were significantly lower than those at T0(P<0.05),DBP and RR at T4-T5 were significantly lower than those at T0(P<0.05).In dexmedetomidine group,HR at T3-T5 was significantly lower than that at T0(P<0.05).HR at T5 and RR at T4-T5 in propofol group were lower than those in control group(P<0.05).SBP in propofol group at T4-T5 was lower than that in control group and dexmedetomidine group(P<0.05).Conclusion Dexmedetomidine can obtain effective sedation stable hemodynamics in patients with hypertension during combined spinal epidural anesthesia.