右美托咪定对老年腰硬联合麻醉患者镇静、呼吸及血流动力学的影响
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摘要
目的探讨右美托咪定对老年腰硬联合麻醉患者的镇静、呼吸及血流动力学的影响。方法选取2017年5月～2018年5月在我院择期行腰硬联合麻醉的老年患者91例,分为右美托咪定组(D组,n=46)和咪达唑仑组(M组,n=45)。患者麻醉后给予镇静药物,D组给予右美托咪定,M组给予咪达唑仑,评价时间点分别为给药前(T0)、给药10min后(T1)、给药20min后(T2)、给药30min后(T3)、给药60min后(T4)。用警觉/镇静视觉(OAA/S)评价镇静效果,记录患者的心率(HR)和平均动脉压(MAP),呼吸速率(RR)和血氧饱和度(SpO_2),最后记录不良反应发生情况。结果 M组和D组T1～T4 OAA/S评分均低于T0,M组显著低于D组(P<0.05);两组T0～T4 HR比较差异无统计学意义(P>0.05),M组T1～T4与T0 HR比较差异无统计学意义(P>0.05),D组T1～T4HR低于T0(P<0.05);M组T2～T4 MAP低于D组(P<0.05);两组T1～T4 MAP低于T0(P<0.05);M组T1～T4 SPO_2水平低于D组(P<0.05);两组SPO_2水平与T0比较差异无统计学意义(P>0.05); D组不良反应发生率低于M组(P<0.05)。结论老年腰硬联合麻醉患者使用右美托咪定镇静效果良好,呼吸抑制作用轻,血流动力学稳定,还能降低寒颤、恶心呕吐、气道梗阻等不良反应发生率,可在临床进一步推广应用。
Objective To investigate effects of dexmedetomidine on sedation, respiratory depression and hemodynamics in elderly patients underwent combined spinal epidural anesthesia. Methods 91 elderly patients underwent combined spinal epidural anesthesia in our hospital from May 2017 to May 2018 were enrolled and divided into group D(dexmedetomidine) and group M(midazolam) according to the different sedative medications. The alertness/sedation(OAA/S) scores, heart rate(HR) and mean arterial pressure(MAP), respiration rate(RR) and oxygen saturation(SpO_2) were recorded at five time points, e.g. before anesthesia(T0), 10 min(T1), 20 min(T2), 30 min(T3) and 60 min(T4) after sedative administration were observed. The adverse reactions were also recorded. Results The OAA/S scores at T1～T4 were decreased in both groups compared with those at T0, and were lower in group M than in group D(P<0.05). The HR of two groups at T0～T4 had no difference(P>0.05); The HR in the group M at T1～T4 had no difference with that at T0(P>0.05), while in group D, the HR at T1～T4 was lower than that at T0(P<0.05). The MAP level of group M at T2～T4 was lower than that of group D(P<0.05). The MAP levelat T1～T4 were lower than those at T0 in both groups(P<0.05). The SPO_2 at T1～T4 in group M was lower than that of group D(P<0.05). The SPO_2 in the both groups at T1～T4 had no difference with that at T0(P>0.05). The incidence of adverse reactions including body motion, nausea and vomiting, respiratory depression, upper airway obstruction, and chills in group M was 37.8%, which was higher than 8.7% in group D including body motion, upper airway obstruction, and chills. Conclusion The application of dexmedetomidine exists good sedative effect, mild respiratory inhibition and stable hemodynamics for elderly patients underwent combined spinal epidural anesthesia, which can reduce the incidence of adverse reactions such as chills, nausea and vomiting, body movement and airway obstruction.
Objective To investigate effects of dexmedetomidine on sedation, respiratory depression and hemodynamics in elderly patients underwent combined spinal epidural anesthesia. Methods 91 elderly patients underwent combined spinal epidural anesthesia in our hospital from May 2017 to May 2018 were enrolled and divided into group D(dexmedetomidine) and group M(midazolam) according to the different sedative medications. The alertness/sedation(OAA/S) scores, heart rate(HR) and mean arterial pressure(MAP), respiration rate(RR) and oxygen saturation(SpO_2) were recorded at five time points, e.g. before anesthesia(T0), 10 min(T1), 20 min(T2), 30 min(T3) and 60 min(T4) after sedative administration were observed. The adverse reactions were also recorded. Results The OAA/S scores at T1～T4 were decreased in both groups compared with those at T0, and were lower in group M than in group D(P<0.05). The HR of two groups at T0～T4 had no difference(P>0.05); The HR in the group M at T1～T4 had no difference with that at T0(P>0.05), while in group D, the HR at T1～T4 was lower than that at T0(P<0.05). The MAP level of group M at T2～T4 was lower than that of group D(P<0.05). The MAP levelat T1～T4 were lower than those at T0 in both groups(P<0.05). The SPO_2 at T1～T4 in group M was lower than that of group D(P<0.05). The SPO_2 in the both groups at T1～T4 had no difference with that at T0(P>0.05). The incidence of adverse reactions including body motion, nausea and vomiting, respiratory depression, upper airway obstruction, and chills in group M was 37.8%, which was higher than 8.7% in group D including body motion, upper airway obstruction, and chills. Conclusion The application of dexmedetomidine exists good sedative effect, mild respiratory inhibition and stable hemodynamics for elderly patients underwent combined spinal epidural anesthesia, which can reduce the incidence of adverse reactions such as chills, nausea and vomiting, body movement and airway obstruction.
引文
[1] 秦树国,赵明,周颖.全身麻醉和腰硬联合麻醉对老年全髋关节置换术术后麻醉恢复期的影响[J].中国老年学杂志,2016,36(6):1395-1397.
[2] 安仙泉,方美丹,王聪,等.右美托咪定与咪达唑仑复合腰硬联合麻醉对老年髋关节置换术患者早期认知功能和炎症因子的影响[J].中国老年学,2017,37(2):428-429.
[3] 秦树国,赵明,周颖.全身麻醉和腰硬联合麻醉对老年全髋关节置换术术后麻醉恢复期的影响[J].中国老年学杂志,2016,36(6):1395-1397.
[4] Xiang Y,Ye W,Sun N,et al.Analgesic and Sedative Effects of Dezocine and Midazolam During Vitrectomy[J].Current Eye Research,2016,41(11):1460-1464.
[5] 李琴琴,陈楠,杨涛,等.咪达唑仑与丙泊酚联合使用时对无痛胃肠镜中老年患者术后认知功能的影响[J].实用医学杂志,2017,33(15):2565-2568.
[6] 郑永超,黄燕,姜虹.右美托咪定对老年高血压患者全麻诱导气管插管应激反应的影响[J].重庆医学,2016,45(9):1220-1222.
[7] Farag E,Argalious M,Sessler DI,et al.Use of α(2)-Agonists in Neuroanesthesia:An Overview[J].Ochsner Journal,2011,11(1):57-69.
[8] 陈章玲,曹德权,徐军美,等.右美托咪定镇静时BIS与OAA/S评分的相关性研究[J].临床麻醉学杂志,2014,30(5):434-436.
[9] 张韫辉,任杰,高金贵,等.血清儿茶酚胺浓度反映右美托咪定复合全身麻醉深度的可靠性[J].中华麻醉学杂志,2016,36(10):1240-1242.
[10] Fukuda K,Ichikawa M,Takagi T,et al.Dexmedetomidine Sedation Effective for a Case with Catecholamine-and Diuretics-resistant Systolic Heart Failure[J].Journal of Cardiac Failure,2013,19(10):S161-S161.
[11] 陈晓梅,陈广福.右美托咪定对颅内肿瘤手术患者血流动力学的影响及脑保护作用[J].临床麻醉学杂志,2015,31(1):15-17.
[12] Park HY,Kim JY,Cho SH,et al.The effect of low-dose dexmedetomidine on hemodynamics and anesthetic requirement during bis-spectral index-guided total intravenous anesthesia.[J].Journal of Clinical Monitoring & Computing,2015,30(4):1-7.
[13] Das A,Halder S,Chattopadhyay S,et al.Effect of Two Different Doses of Dexmedetomidine as Adjuvant in Bupivacaine Induced Subarachnoid Block for Elective Abdominal Hysterectomy Operations:A Prospective,Double-blind,Randomized Controlled Study[J].Oman Medical Journal,2015,30(4):257-263.
[14] 王春艳,谢丹,曾星,等.麻醉前使用右美托咪定或咪达唑仑临床效果的比较[J].临床麻醉学杂志,2013,29(6):548-550.
[15] 钟毅,高鸿,殷永强,等.右美托咪定对健康自愿者窦房结功能的影响[J].实用医学杂志,2015,31(1):119-121.
[16] 赵艾华,李亚南,刘祥,等.咪达唑仑、异丙酚及右美托咪定用于椎管内麻醉辅助镇静时顺行性遗忘作用的比较[J].中华麻醉学杂志,2017,37(4):458-460.
[17] Yu J,Lu Y,Dong C,et al.Premedication with intravenous dexmedetomidine-midazolam suppresses fentanyl-induced cough[J].Irish Journal of Medical Science,2012,181(4):517-520.
[18] Ergenoglu P,Akin S,Bali C,et al.Effect of low dose dexmedetomidine premedication on propofol consumption in geriatric end stage renal disease patients[J].Brazilian Journal of Anesthesiology,2015,65(5):326-332.
[19] 戴东明,胡乃浩,吴淦,等.右美托咪定预防腰—硬联合麻醉后寒颤的临床观察[J].临床合理用药杂志,2017,10(34):77-78.
[20] 赵蕊,张康秦.不同麻醉药物对幕上脑肿瘤患者诱导麻醉后颅内压及脑灌注压的影响[J].陕西医学杂志,2016,45(4):468-469.
[21] 何永传,戴载深.不同剂量右美托咪定单次泵注对腰硬联合麻醉患者寒战发生及复苏舒适质量的影响[J].广东医学,2016,37(18):2707-2710.
[22] Hara M,Zhou ZY,Jr HCH.α2-Adrenergic receptor and isoflurane modulation of presynaptic Ca2+ influx and exocytosis in hippocampal neurons[J].Anesthesiology,2016,125(3):535-563.
[23] 翟晓莉.右美托咪定用于椎管麻醉中寒颤预防的临床观察[J].航空航天医学杂志,2015,26(9):1130-1132.
[2] 安仙泉,方美丹,王聪,等.右美托咪定与咪达唑仑复合腰硬联合麻醉对老年髋关节置换术患者早期认知功能和炎症因子的影响[J].中国老年学,2017,37(2):428-429.
[3] 秦树国,赵明,周颖.全身麻醉和腰硬联合麻醉对老年全髋关节置换术术后麻醉恢复期的影响[J].中国老年学杂志,2016,36(6):1395-1397.
[4] Xiang Y,Ye W,Sun N,et al.Analgesic and Sedative Effects of Dezocine and Midazolam During Vitrectomy[J].Current Eye Research,2016,41(11):1460-1464.
[5] 李琴琴,陈楠,杨涛,等.咪达唑仑与丙泊酚联合使用时对无痛胃肠镜中老年患者术后认知功能的影响[J].实用医学杂志,2017,33(15):2565-2568.
[6] 郑永超,黄燕,姜虹.右美托咪定对老年高血压患者全麻诱导气管插管应激反应的影响[J].重庆医学,2016,45(9):1220-1222.
[7] Farag E,Argalious M,Sessler DI,et al.Use of α(2)-Agonists in Neuroanesthesia:An Overview[J].Ochsner Journal,2011,11(1):57-69.
[8] 陈章玲,曹德权,徐军美,等.右美托咪定镇静时BIS与OAA/S评分的相关性研究[J].临床麻醉学杂志,2014,30(5):434-436.
[9] 张韫辉,任杰,高金贵,等.血清儿茶酚胺浓度反映右美托咪定复合全身麻醉深度的可靠性[J].中华麻醉学杂志,2016,36(10):1240-1242.
[10] Fukuda K,Ichikawa M,Takagi T,et al.Dexmedetomidine Sedation Effective for a Case with Catecholamine-and Diuretics-resistant Systolic Heart Failure[J].Journal of Cardiac Failure,2013,19(10):S161-S161.
[11] 陈晓梅,陈广福.右美托咪定对颅内肿瘤手术患者血流动力学的影响及脑保护作用[J].临床麻醉学杂志,2015,31(1):15-17.
[12] Park HY,Kim JY,Cho SH,et al.The effect of low-dose dexmedetomidine on hemodynamics and anesthetic requirement during bis-spectral index-guided total intravenous anesthesia.[J].Journal of Clinical Monitoring & Computing,2015,30(4):1-7.
[13] Das A,Halder S,Chattopadhyay S,et al.Effect of Two Different Doses of Dexmedetomidine as Adjuvant in Bupivacaine Induced Subarachnoid Block for Elective Abdominal Hysterectomy Operations:A Prospective,Double-blind,Randomized Controlled Study[J].Oman Medical Journal,2015,30(4):257-263.
[14] 王春艳,谢丹,曾星,等.麻醉前使用右美托咪定或咪达唑仑临床效果的比较[J].临床麻醉学杂志,2013,29(6):548-550.
[15] 钟毅,高鸿,殷永强,等.右美托咪定对健康自愿者窦房结功能的影响[J].实用医学杂志,2015,31(1):119-121.
[16] 赵艾华,李亚南,刘祥,等.咪达唑仑、异丙酚及右美托咪定用于椎管内麻醉辅助镇静时顺行性遗忘作用的比较[J].中华麻醉学杂志,2017,37(4):458-460.
[17] Yu J,Lu Y,Dong C,et al.Premedication with intravenous dexmedetomidine-midazolam suppresses fentanyl-induced cough[J].Irish Journal of Medical Science,2012,181(4):517-520.
[18] Ergenoglu P,Akin S,Bali C,et al.Effect of low dose dexmedetomidine premedication on propofol consumption in geriatric end stage renal disease patients[J].Brazilian Journal of Anesthesiology,2015,65(5):326-332.
[19] 戴东明,胡乃浩,吴淦,等.右美托咪定预防腰—硬联合麻醉后寒颤的临床观察[J].临床合理用药杂志,2017,10(34):77-78.
[20] 赵蕊,张康秦.不同麻醉药物对幕上脑肿瘤患者诱导麻醉后颅内压及脑灌注压的影响[J].陕西医学杂志,2016,45(4):468-469.
[21] 何永传,戴载深.不同剂量右美托咪定单次泵注对腰硬联合麻醉患者寒战发生及复苏舒适质量的影响[J].广东医学,2016,37(18):2707-2710.
[22] Hara M,Zhou ZY,Jr HCH.α2-Adrenergic receptor and isoflurane modulation of presynaptic Ca2+ influx and exocytosis in hippocampal neurons[J].Anesthesiology,2016,125(3):535-563.
[23] 翟晓莉.右美托咪定用于椎管麻醉中寒颤预防的临床观察[J].航空航天医学杂志,2015,26(9):1130-1132.