右美托咪定持续输注对老年胃肠手术患者血流动力学麻醉药用量及术后苏醒的影响

摘要

Objective To explore the influences of dexmedetomidine continuous infusion on hemodynam‐ics ,anesthetic dosage and postoperative analepsia of senile patients undergoing gastrointestinal operation . Methods Ninety senile patients undergoing gastrointestinal operation were randomly assigned to two groups of 45 ones each ,both groups received routine anesthesia ,continuous infusion of dexmedetomidine was given to observation group ,and isovolumetric 0 .9% sodium chloride solution to control group .Chan‐ges of hemodynamics ,anesthetic dosage and postoperative analepsia time at different time point were ob‐served .Results There were very significant group differences in mean arterial pressures when trachea cannula ,cutting and extubation (P<0 .01);there were very significant group differences in heart rates at the end of continuous infusion ,when trachea cannula ,within 3 minutes after trachea cannula and when cutting and extubation (P<0 .05 or 0 .01) .Remifentanil and propofol dosage were significantly lower in observation than in control group (P< 0 .01) and postoperative analepsia time had no significant group difference (P>0 .05);systolic pressure and heart rate after intubation and when extubation were signifi‐cantly lower in observation than in control group (P<0 .01);bispectral index 60 ,70 ,80 as well as agryp‐nodal time were significantly longer in observation than in control group (P<0 .05 or 0 .01) .Conclusion Dexmedetomidine continuous infusion for elderly patients undergoing gastrointestinal surgery could reduce anesthetic dosage ,is beneficial to the stabilization of patients’ hemodynamics ,doesn’ t influence pa‐tients’ analepsia time ,and deserves clinical gener‐alization and application .%目的：探讨右美托咪定持续输注对接受胃肠手术治疗老年患者血流动力学、麻醉药用量及术后苏醒的影响。方法将90例行胃肠手术治疗的老年患者按随机数字表法分为观察组和对照组，每组45例，两组均予以常规麻醉，观察组经静脉持续输注右美托咪定，对照组经静脉持续输注等容量的0．9％氯化钠溶液。观察两组手术不同时点血流动力学、麻醉药用量及术后苏醒时间的变化。结果气管插管时、切皮时以及拔管时，两组平均动脉压水平比较差异有极显著性（P＜0．01）；药液持续输注结束时、气管插管时、气管插管后3 min、切皮时以及拔管时，两组心率比较差异有显著性（ P＜0．05或0．01）。观察组应用麻醉药瑞芬太尼、丙泊酚剂量显著低于对照组（P＜0．01），术后苏醒时间与对照组比较差异无显著性（P＞0．05）；插管后、拔管时的平均动脉压、心率均显著低于对照组（ P＜0．01）；脑电双频谱指数60、脑电双频谱指数70、脑电双频谱指数80、睁眼时间均显著长于对照组（ P＜0．05或0．01）。结论对接受胃肠手术治疗的老年患者予以右美托咪定持续输注，可减少麻醉用药剂量，有利于患者血流动力学的稳定，且不影响患者的苏醒时间，值得临床推广应用。