右美托咪定在老年患者全身麻醉中应用效果研究
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摘要
目的评价右美托咪定对老年患者围手术期血流动力学、术后拔管时间及术后恶心呕吐(PONV)发生情况的影响。方法回顾性分析2017年4月至2018年3月于该院行全身麻醉气管插管手术208例老年患者的临床资料。按照是否使用右美托咪定将患者分为右美组(102例)和对照组(106例)。比较手术开始时(T1)、手术开始后30min(T2)、手术结束时(T3)、气管拔管即刻(T4)、拔管后5min(T5)时2组患者平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(SpO2),以及拔管时间、术后24h PONV及术中低血压、心动过缓发生率。结果在所有观察时刻,右美组患者HR均低于对照组,在T1、T2、T4及T5时刻2组HR比较,差异均有统计学意义(P<0.05)。在所有观察时刻,右美组患者MAP均小于对照组,T1、T2、T4及T5时刻2组MAP比较,差异均有统计学意义(P<0.05)。T4时刻,右美组患者SpO2明显高于对照组,差异有统计学意义(P<0.01),而2组患者术后拔管时间比较,差异无统计学意义(P>0.05)。2组患者低血压、PONV发生率比较,差异均有统计学意义(P<0.05或0.01)。2组患者术中心动过缓发生率比较,差异无统计学意义(P>0.05)。结论在老年患者全身麻醉过程中,使用右美托咪定有稳定血流动力学的作用,可减轻患者心血管应激反应;右美托咪定的使用不增加患者术后拔管时间,有呼吸保护作用,并能降低患者PONV发生率,有利于提高老年患者全身麻醉的安全性。
Objective To evaluate the effect of dexmedetomidine on perioperative hemodynamics,postoperative extubation time and PONV in elderly patients.Methods The clinical data of 208 elderly patients who underwent tracheal intubation under general anesthesia in the hospital from April 2017 to March 2018 were retrospectively analyzed.Patients were divided into dexmedetomidine group(102 cases)and control group(106 cases)according to whether dexmedetomidine was used.MAP,HR,SpO2,extubation time,postoperative nausea and vomiting,intraoperative hypotension and bradycardia were compared between the two groups at the beginning of surgery(T1),30 min after surgery(T2),at the end of surgery(T3),immediately after tracheal extubation(T4)and 5 min after extubation(T5).Results At all observation times,HR of patients in the dexmedetomidine group was lower than that in the control group,and the differences of HR between the two groups were statistically significant in T1,T2,T4 and T5 time(P<0.05).At all observation times,MAP of patients in the dexmedetomidine group was smaller than that in the control group,and the differences of MAP between the two groups were statistically significant in T1,T2,T4 and T5 time(P<0.05).At T4,SpO2 of patients in the dexmedetomidine group was significantly higher than that in the control group,and the difference was statistically significant(P<0.01),while the difference in postoperative extubation time between the two groups was not statistically significant(P>0.05).Comparison of hypotension and PONV incidence between the two groups showed statistically significant differences(P<0.05 or 0.01).There was no significant difference in the incidence of intraoperative bradycardia between the two groups(P>0.05).Conclusion Dexmedetomidine can stabilize hemodynamics and reduce cardiovascular stress in elderly patients during general anesthesia.In addition,the use of dexmedetomidine does not increase the time of extubation after surgery,has a protective effect on respiration,and can reduce the incidence of PONV in patients,which is conducive to improving the safety of general anesthesia in elderly patients.
Objective To evaluate the effect of dexmedetomidine on perioperative hemodynamics,postoperative extubation time and PONV in elderly patients.Methods The clinical data of 208 elderly patients who underwent tracheal intubation under general anesthesia in the hospital from April 2017 to March 2018 were retrospectively analyzed.Patients were divided into dexmedetomidine group(102 cases)and control group(106 cases)according to whether dexmedetomidine was used.MAP,HR,SpO2,extubation time,postoperative nausea and vomiting,intraoperative hypotension and bradycardia were compared between the two groups at the beginning of surgery(T1),30 min after surgery(T2),at the end of surgery(T3),immediately after tracheal extubation(T4)and 5 min after extubation(T5).Results At all observation times,HR of patients in the dexmedetomidine group was lower than that in the control group,and the differences of HR between the two groups were statistically significant in T1,T2,T4 and T5 time(P<0.05).At all observation times,MAP of patients in the dexmedetomidine group was smaller than that in the control group,and the differences of MAP between the two groups were statistically significant in T1,T2,T4 and T5 time(P<0.05).At T4,SpO2 of patients in the dexmedetomidine group was significantly higher than that in the control group,and the difference was statistically significant(P<0.01),while the difference in postoperative extubation time between the two groups was not statistically significant(P>0.05).Comparison of hypotension and PONV incidence between the two groups showed statistically significant differences(P<0.05 or 0.01).There was no significant difference in the incidence of intraoperative bradycardia between the two groups(P>0.05).Conclusion Dexmedetomidine can stabilize hemodynamics and reduce cardiovascular stress in elderly patients during general anesthesia.In addition,the use of dexmedetomidine does not increase the time of extubation after surgery,has a protective effect on respiration,and can reduce the incidence of PONV in patients,which is conducive to improving the safety of general anesthesia in elderly patients.
引文
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[13]安丽,高鸿,段宏伟,等.右美托咪定引起心动过缓的心脏电生理机制及其与钾通道的关系[J].实用医学杂志,2015,31(21):3496-3498.
[14]SEO KH,KIM YI,KIM YS.Optimal dose of dexmedetomidine for attenuating cardiovascular response during emergence in patients undergoing total laparoscopic hysterectomy[J].J Int Med Res,2014,42(5):1139-1149.
[15]GAN TJ,DIEMUNSCH P,HABIB AS,et al.Consensus guidelines for the management of postoperative nausea and vomiting[J].Anesth Analg,2014,118(1):85-113.
[16]BAKRI MH,ISMAIL EA,IBRAHIM A.Comparison of dexmedetomidine and dexamethasone for prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy[J].Korean J Anesthesiol,2015,68(3):254-260.
[17]LIANG XI,ZHOU MI,FENG JJ,et al.Efficacy of dexmedetomidine on postoperative nausea and vomiting:a meta-analysis of randomized controlled trials[J].Int J Clin Exp Med,2015,8(6):8450-8471.
[18]GENG ZY,LIU YF,WANG SS,et al.Intra-operative dexmedetomidine reduces early postoperative nausea but not vomiting in adult patients after gynaecological laparoscopic surgery:a randomised controlled trial[J].Eur J Anaesthesiol,2016,33(10):761-766.
[19]LE GUEN M,LIU N,TOUNOU F,et al.Dexmedetomidine reduces propofol and remifentanil requirements during bispectral index-guided closed-loop anesthesia:a double-blind,placebo-controlled trial[J].Anesth Analg,2014,118(5):946-955.
[2] FRANCK M,RADTKE FM,PRAHS C,et al.Documented intraoperative hypotension according to the three most common definitions does not match the application of antihypotensive medication[J].J Int Med Res,2011,39(3):846-856.
[3] BIJKER JB,VAN KLEI WA,VERGOUWE Y,et al.Intraoperative hypotension and 1-year mortality after noncardiac surgery[J].Anesthesiology,2009,111(6):1217-1226.
[4] MONK TG,BRONSERT MR,HENDERSON WG,et al.Association between intraoperative hypotension and hypertension and 30-day postoperative mortality in noncardiac surgery[J].Anesthesiology,2015,123(2):307-319.
[5] EZZATI M,OZA S,DANAEI G,et al.Trends and cardiovascular mortality effects of state-level blood pressure and uncontrolled hypertension in the United States.Circulation,2008,117(7):905-914.
[6] REICH DL,BENNETT-GUERRERO E,BODIAN CA,et al.Intraoperative tachycardia and hypertension are independently associated with adverse outcome in noncardiac surgery of long duration[J].Anesth Analg,2002,95(2):273-277.
[7] REICH DL,BODIAN CA,KROL M,et al.Intraoperative hemodynamic predictors of mortality,stroke,and myocardial infarction after coronary artery bypass surgery[J].Anesth Analg,1999,89(4):814-822.
[8] ZHAO J,ZHOU C.The protective and hemodynamic effects of dexmedetomidine on hypertensive cerebral hemorrhage patients in the perioperative period[J].Exp Ther Med,2016,12(5):2903-2908.
[9] KUNISAWA T,NAGATA O,NAGASHIMA M,et al.Dexmedetomidine suppresses the decrease in blood pressure during anesthetic induction and blunts the cardiovascular response to tracheal intubation[J].J Clin Anesth,2009,21(3):194-199.
[10]SU X,MENG ZT,WU XH,et al.Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery:a randomised,double-blind,placebo-controlled trial[J].Lancet,2016,388(10054):1893-1902.
[11]ICE CJ,PERSONETT HA,FRAZEE EN,et al.Risk factors for Dexmedetomidine-Associated hemodynamic instability in noncardiac intensive care unit patients[J].Anesth Analg,2016,122(2):462-469.
[12]HUI C,CARDINALE M,YEGNESWARAN B.Significant bradycardia in critically ill patients receiving dexmedetomidine and fentanyl[J].Case Rep Crit Care,2017,2017:4504207.
[13]安丽,高鸿,段宏伟,等.右美托咪定引起心动过缓的心脏电生理机制及其与钾通道的关系[J].实用医学杂志,2015,31(21):3496-3498.
[14]SEO KH,KIM YI,KIM YS.Optimal dose of dexmedetomidine for attenuating cardiovascular response during emergence in patients undergoing total laparoscopic hysterectomy[J].J Int Med Res,2014,42(5):1139-1149.
[15]GAN TJ,DIEMUNSCH P,HABIB AS,et al.Consensus guidelines for the management of postoperative nausea and vomiting[J].Anesth Analg,2014,118(1):85-113.
[16]BAKRI MH,ISMAIL EA,IBRAHIM A.Comparison of dexmedetomidine and dexamethasone for prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy[J].Korean J Anesthesiol,2015,68(3):254-260.
[17]LIANG XI,ZHOU MI,FENG JJ,et al.Efficacy of dexmedetomidine on postoperative nausea and vomiting:a meta-analysis of randomized controlled trials[J].Int J Clin Exp Med,2015,8(6):8450-8471.
[18]GENG ZY,LIU YF,WANG SS,et al.Intra-operative dexmedetomidine reduces early postoperative nausea but not vomiting in adult patients after gynaecological laparoscopic surgery:a randomised controlled trial[J].Eur J Anaesthesiol,2016,33(10):761-766.
[19]LE GUEN M,LIU N,TOUNOU F,et al.Dexmedetomidine reduces propofol and remifentanil requirements during bispectral index-guided closed-loop anesthesia:a double-blind,placebo-controlled trial[J].Anesth Analg,2014,118(5):946-955.