右美托咪定预先给药对老年高血压患者双腔气管插管期间麻醉深度及心肌氧耗的影响

摘要

目的：观察中等剂量右美托咪定预先给药对老年高血压患者全麻诱导双腔气管插管期间麻醉深度和心肌氧耗的影响。方法：选择拟行双腔气管插管老年高血压患者40例，ASAⅡ或Ⅲ级，随机数字表达法分为对照组（ C组）和右美托咪定组（D组），每组20例。 D组于麻醉诱导前10 min静脉恒速输注右美托咪定0．5μg／kg，C组于麻醉诱导前静脉恒速输注等量生理盐水。观察并记录两组静脉输注前（ T1）及静脉输注后2 min（ T2）、4 min（ T3）、6 min（ T4）、8 min（ T5）、10 min（ T6），双腔气管插管前（T7）、双腔气管插管后即刻（T8）各指标变化，包括CSI（脑功能状态指数）、SBP（收缩压）、HR（心率）、RPP（心率收缩压乘积）。结果：与C组比较，D组在T5、T6、T8时点，CSI、SBP、HR、RPP明显降低，差异有统计学意义（P＜0．05）；与T7时点比较，C组T8时点CSI、SBP、HR、RPP显著增高，差异有统计学意义（ P＜0．05）。结论：右美托咪定预先给药能对老年高血压患者产生满意的镇静效应，同时能够适当预防老年高血压患者双腔气管插管时术中知晓的发生，降低心肌氧耗，值得临床推广。%Objective:To observe the effects of dexmedetomidine premedication in moderate dose on the depth of anesthesia and myocardial oxygen con-sumption in elderly patients with hypertension during anesthetic induction and double lumen endotracheal intubation .Methods:Forty elderly hypertensive patients(ASA Ⅱor III ) undergoing double lumen endotracheal intubation were equally randomized into dexmedetomidine group (group D) and control group (group C) by the table of random numbers.Group D intravenously received 0.5 μg/kg of dexmedetomidine for 10 minutes before anesthetic induc-tion,and group C were given the same volume of 0.9% saline as the similar protocol.The two groups were observed regarding the indicator changes,inclu-ding cerebral state index(CSI),systolic blood pressure(SBP),heart rate(HR) and rate pressure product(RPP) maintained before injection of dexmedeto-midine or normal saline ( T1 ) ,and administration of it at 2 min( T2 ) ,4 min( T3 ) ,6 min( T4 ) ,8 min ( T5 ) and 10 min( T6 ) as well as before double lu-men endotracheal tube placement(T7) and instant intubation(T8).Results:Compared with group C,CSI,SBP,HR and RPP were significantly decreased in group D at T5,T6 and T8(P<0.05),and CSI,SBP,HR and RPP were significantly elevated at T8 in group C as compared with those at T7(P<0. 05 ) .Conclusion:Pre-use of dexmedetomidine in moderate dose can produce satisfactory sedative effects in elderly patients with hypertension , moderately prevent intraoperative awareness and reduce myocardial oxygen consumption during double lumen endotracheal intubation , and is worthy of wider clinical recommendation.