右美托咪定双相血流动力学变化在老年患者全麻诱导中的应用
The application of the biphasic hemodynamic change of dexmedetomidine in elderly patients during the general anesthesia induction
-
摘要: 目的：探讨右美托咪定的双相血流动力学变化在老年患者全麻诱导中的应用。方法：选择全麻老年患者50例，ASAⅠ～Ⅱ级，随机分为右美托咪定组（D组）和0.9%氯化钠注射液组（C组），每组25例。D组麻醉诱导前给予右美托咪定负荷量0.5 μg/kg稀释至20 mL泵注，10 min输注完毕，再以0.3 μg·kg-1·h-1泵注至插管后5 min；C组静脉泵注等量0.9%氯化钠注射液。分别记录入室后（T0），右美托咪定负荷量结束后（T1），气管插管前（T2）及插管后1 min（T3）、3 min（T4）、5 min（T5）时的平均动脉压（MAP）、心率（HR）。结果：2组患者MAP在T2～T5时点均较T0下降（P < 0.05～P < 0.01）；D组MAP在T1、T2、T4、T5时点与T3差异均无统计学意义（P>0.05），C组T1和T2时点MAP与T3差异均有统计学意义（P<0.01）；D组T2时点MAP高于C组（P<0.05）。D组患者HR在T1、T2、T4和T5时点明显低于T0（P<0.01）；T2、T4和T5的HR均显著低于T3（P<0.01）；C组患者T4和T5时点HR均低于T0（P<0.05）；D组T1、T2和T5的HR均明显低于C组（P<0.01）。结论：全麻诱导过程中给予右美托咪定可以升高动脉血压，一定程度地抑制了全麻药物引起的血压下降，同时降低HR，减弱气管插管反应，稳定心血管功能。Abstract: Objective: To investigate the application value of the biphasic hemodynamic changes of dexmedetomidine(DEX) in elderly patients during general anesthesia induction.Methods: Fifty general anesthesia elderly patients with ASAⅠto Ⅱ were randomly divided into the DEX group(group D) and saline group(group C)(25 cases each group).Before general anesthesia,the group D were injected with 0.5 μg/kg of DEX(20 mL) for 10 mins,and then with 0.3 μg·kg-1·h-1 for 5 mins after intubation,the group C were injected with the same volume saline.The mean arterial pressure(MAP) and heart rate(HR) in two groups were recorded after entering the operation room(T0),the end of DEX load(T1),before tracheal intubation(T2) and after 1,3 and 5 mins of intubation(T3,T4 and T5).Results: Compared with T0,the MAP in two groups from T2 to T5 decreased significantly(P<0.05 to P<0.01).The differences of the MAP in group D between T1,T2,T4,T5 and T3 were not statistically significant(P>0.05),the differences of the MAP in group C between T1,T2 and T3 were statistically significant(P<0.01),and the MAP in group D at T2 was higher than that in group C(P<0.05).Among group D,the HR at T1,T2,T4 and T5 were obviously lower than that at T0,the HR at T2,T4 and T5 were significantly lower than that at T3(P<0.01).The HR in group C at T4 and T5 were lower than that at T0(P<0.05),the HR in group D at T1,T2 and T5 were significantly lower than that in group C(P<0.01).Conclusions: The application of DEX during the general anesthesia induction can increase the arterial blood pressure,inhibit the blood pressure decreasing resulted from the anesthesia,reduce the heart rate and response of tracheal intubation and stable cardiovascular function.
-
Key words:
- anesthesia /
- dexmedetomidine /
- biphasic hemodynamic change /
- elderly
-
[1] NATIU OO,KHETERPAL S,MORRIS M,et al.Incidence and risk factors for preincision hypotension in a noncardiac pediatric surgical population[J].Paediatr Anaesth,2009,19(3):232. [2] LIMA EQ,ZANETTA DM,CASTO I,et al.Risk factors for development of acute rena1 failure after liver transplantation[J].Ren Fail,2003,25(4):55. [3] GERLACH AT,DASTA JF.Dexmedetomidine:an updated review[J].Ann Pharmacother,2007,41(2):245. [4] BOERSMA E,KERTAI MD,SCHOUTEN O,et al.Perioperative cardiovascular mortality in noncardiac surgery:validation of the Lee cardiac risk index[J].Am J Med,2005,118(10):1134. [5] MONK TG,SAINI V,WELDON BC,et al.Anesthetic management and one-year mortality after noncardiac surgery[J].Anesth Analg,2005,100(1):4. [6] REICH DL,HOSSAIN S,KROL M,et al.Predictors of hypotension after induction of general anesthesia[J].Anesth Analg,2005,101(33):622. [7] 舒爱华,占乐云.右美托咪定对老年患者全麻恢复期心率变异性的影响[J].临床麻醉学杂志,2012,28(7):661. [8] HALL JE,UHRICH TD,BARNEY JA,et al.Sedative,amnestic,and analgesic properties of small-dose dexmedetomidine infusions[J].Anesth Analg,2000,90(3):699. [9] XU H,AIBIKI M,SEKI K,et al.Effects of dexmedetomidine,an α2-adrenoceptor agonist,on renal sympathetic nerve activity,blood pressure,heart rate and central venous pressure in urethane-anesthetized rabbits[J].J Auton Nerv Syst,1998,71(1):48. [10] 何平,朱德浩,韦鹏,等.右美托咪定联合硝酸甘油在经鼻微创垂体瘤切除术的应用效果[J].蚌埠医学院学报,2015,40(5):602. [11] AHO M,ERKOLA O,KALLIO A,et al.Comparison of dexmedetomidine and midazolam sedation and antagonism of dexmedetomidine with atipamezole[J].J Clin Anesth,1993,5(3):194. [12] AANTAA R,KANTO J,SCHEININ M,et al.Dexmedetomidine,an α2-adrenoceptor agonist,reduces anesthetic requirements for patients undergoing minor gynecologic surgery[J].Anesthesiology,1990,73(2):230. [13] EBERT TJ,HALL JE,BARNEY JA,et al.The effects of increasing plasma concentrations of dexmedetomidin in humans[J].Anesthesiology,2000,93(2):382. [14] LAWRENCE CJ,DE LANGE S.Effects of a single pre-operative dexmedetomidine dose on isoflurane requirements and peri-operative haemodynamic stability[J].Anaesthesia,1997,52(8):736. [15] GERTLER R,BROWN HC,MITCHELL DH,et al.Dexmedetomidine:a novel sedative-analgesic agent[J].Proc(Bayl Univ Med Cent),2001,14(1):13. [16] JALONEN J,HYNYNEN M,KUITUNEN A,et al.Dexmedetomidine as an anesthetic adjunct in coronary artery bypass grafting[J].Anesthesiology,1997,86(2):331. -
点击查看大图
计量
- 文章访问数: 2279
- HTML全文浏览量: 338
- PDF下载量: 112
- 被引次数: 0
下载:
