右美托咪定联合丙泊酚对老年患者全身麻醉苏醒期躁动及血浆皮质醇水平的影响
|
摘要
目的:探讨右美托咪定联合丙泊酚对老年患者全身麻醉苏醒期躁动及血浆皮质醇水平的影响。方法:选取2016年1月-2017年10月本院择期全身麻醉下行骨科手术的老年患者60例作为研究对象,按照随机数字表法将其分为丙泊酚组(P组)和右美托咪定联合丙泊酚组(DP组),每组30例。DP组在麻醉诱导前给予右美托咪定0.5μg/kg(15 min),术中以0.2μg/(kg·h)持续输注至手术结束前5 min。两组均给予阿曲库铵0.7 mg/kg、丙泊酚1～3 mg/kg、舒芬太尼效应室靶控浓度0.2μg/kg诱导插管,术中通过调节丙泊酚靶控血浆浓度维持BIS值在45～55。观察比较两组各时间点的血浆皮质醇浓度、Riker镇静和躁动(Riker sedation-agitation scale,RSAS)评分及全身麻醉苏醒期躁动情况。结果:DP组RSAS评分和全身麻醉苏醒期躁动发生率均明显低于P组,差异均有统计学意义(P<0.05)。DP组T0、T1、T2、T3各时间点的血浆皮质醇浓度均明显低于P组,差异均有统计学意义(P<0.05)。结论:丙泊酚血浆靶控输注麻醉下应用右美托咪定可分别抑制与预防全身麻醉下行骨科手术的老年患者苏醒期应激反应和躁动。
Objective:To discuss the effect of Dexmedetomidine combined with Propofol on agitation and plasma cortisol levels during general anesthesia recovery in elderly patients.Method:A total of 60 elderly patients who underwent selective surgeries of orthopedic surgery under general anesthesia in our hospital from January 2016 to October 2017 were selected as the study objects.According to the random number table method,they were divided into Propofol group(group P)and Dexmedetomidine group combined with Propofol group(group DP),30 cases in each group.DP group was given 0.5 μg/kg(15 min)of Dexmedetomidine intravenously before induction of anesthesia,and 0.2 μg/(kg·h)was continuously infused during operation until 5 min before the end of operation.Both groups were given Atracurium 0.7 mg/kg,Propofol 1-3 mg/kg and Sufentanil targetcontrolled concentration 0.2 μg/kg to induce intubation.BIS value was maintained at 45-55 by adjusting Propofol target-controlled plasma concentration during operation.The plasma cortisol concentration at each time point,Riker sedation-agitation scale(RSAS)score and agitation during general anesthesia recovery between the two groups were observed and compared.Result:The RSAS score and incidence of agitation during general anesthesia recovery in group DP were significantly lower than those in group P,the differences were statistically significant(P<0.05).The plasma cortisol concentration at T0,T1,T2 and T3 time points of group DP were significantly lower than those of group P,the differences were statistically significant(P<0.05).Conclusion:The application of Dexmedetomidine under the plasma target-controlled infusion anesthesia with Propofol can inhibit and prevent the irritable response and agitation of the elderly patients undergoing orthopaedic surgery under general anesthesia respectively.
Objective:To discuss the effect of Dexmedetomidine combined with Propofol on agitation and plasma cortisol levels during general anesthesia recovery in elderly patients.Method:A total of 60 elderly patients who underwent selective surgeries of orthopedic surgery under general anesthesia in our hospital from January 2016 to October 2017 were selected as the study objects.According to the random number table method,they were divided into Propofol group(group P)and Dexmedetomidine group combined with Propofol group(group DP),30 cases in each group.DP group was given 0.5 μg/kg(15 min)of Dexmedetomidine intravenously before induction of anesthesia,and 0.2 μg/(kg·h)was continuously infused during operation until 5 min before the end of operation.Both groups were given Atracurium 0.7 mg/kg,Propofol 1-3 mg/kg and Sufentanil targetcontrolled concentration 0.2 μg/kg to induce intubation.BIS value was maintained at 45-55 by adjusting Propofol target-controlled plasma concentration during operation.The plasma cortisol concentration at each time point,Riker sedation-agitation scale(RSAS)score and agitation during general anesthesia recovery between the two groups were observed and compared.Result:The RSAS score and incidence of agitation during general anesthesia recovery in group DP were significantly lower than those in group P,the differences were statistically significant(P<0.05).The plasma cortisol concentration at T0,T1,T2 and T3 time points of group DP were significantly lower than those of group P,the differences were statistically significant(P<0.05).Conclusion:The application of Dexmedetomidine under the plasma target-controlled infusion anesthesia with Propofol can inhibit and prevent the irritable response and agitation of the elderly patients undergoing orthopaedic surgery under general anesthesia respectively.
引文
[1]Blaudszun G,Lysakowski C,Elia N,et al.Effect of perioperative systemicα2 agonists on postoperative morphine consumption and pain intensity:systematic review and meta-analysis of randomized controlled trials[J].Anesthesiology,2012,116(6):1312-1322.
[2]周辉,李世忠,夏月峰.高龄病人的手术麻醉[J].现代医药卫生,2007,23(10):1500-1501.
[3]张丽敏,安辉,邓海峰,等.高龄患者PFNA手术麻醉方法的探讨[J].中国伤残医学,2011,19(5):51-52.
[4]陈顺富,祝贵州,陈忠华.高龄患者上腹部手术的麻醉方法探讨[J].江西医药,2006,41(2):107-109.
[5]王莉,侯锐,胡开进.ASA分级系统在口腔外科门诊治疗中的应用[J].实用口腔医学杂志,2012,28(1):51-54.
[6]程莉莉,李洋,郑文慧,等.不同体位发音时评估Mallampati分级结果与改良Cormach-Lehane分级相关性研究[J].中国医科大学学报,2015,44(8):699-703.
[7]Kim S Y,Kim J M,Lee J H,et al.Efficacy of intraoperative dexmedetomidine infusion on emergence agitation and quality of recovery after nasal surgery[J].British Journal of Anaesthesia,2013,111(2):222-228.
[8]左四琴,王艳.基于Riker镇静躁动评分的护理对神经外科ICU躁动患者并发症的影响[J].中华现代护理杂志,2014,20(11):1316-1318.
[9]杨荣宽.老年全麻手术苏醒期患者躁动发生状况及其危险因素[J].实用临床医药杂志,2016,20(1):163-165.
[10]刘金虎.老年患者全身麻醉术后苏醒期躁动的logistic回归分析[J].中国实验诊断学,2016,20(12):2030-2033.
[11]王灿经.影响全麻苏醒期老年患者躁动的危险因素调查[J].中国现代医生,2012,50(6):14-15.
[12]Yang L,Ying Z,Da-Li W,et al.Risk factors for acquired pneumonia in patients after tracheal intubation under general anesthesia and prevention measures[J].Chinese Journal of Nosocomiology,2013,23(19):4673-4674.
[13]Mayer J,Boldt J,R?hm K D,et al.Desflurane anesthesia after sevoflurane inhaled induction reduces severity of emergence agitation in children undergoing minor ear-nose-throat surgery compared with sevoflurane induction and maintenance[J].Anesthesia&Analgesia,2006,102(2):400-404.
[14]贾俊香,姚向国,梁小玲.右美托咪定预防小儿全身麻醉苏醒期躁动临床效果观察[J].齐齐哈尔医学院学报,2014,35(23):3448-3449.
[15]李定鲲.不同麻醉方式对老年患者术后麻醉恢复期的影响[J].临床合理用药杂志,2014,7(10):159.
[16]钱晓岚,任莹莹,王琦英,等.盐酸右美托咪定的药理作用及临床应用[J].临床研究,2016,24(8):201-202.
[17]张青,王竹梅.右美托咪啶的药理作用及临床应用进展[J].贵州医药,2016,28(5):544-547.
[18]Kumari R,Kumar A,Kumar S,et al.Intravenous dexmedetomidine as an adjunct to subarachnoid block:a simple effective method of better perioperative efficacy[J].Journal of Anaesthesiology Clinical Pharmacology,2017,33(2):203-208.
[19]Koroglu A,Teksan H,Sagir O,et al.A comparison of the sedative,hemodynamic,and respiratory effects of dexmedetomidine and propofol in children undergoing magnetic resonance imaging[J].Anesth Analg,2006,5(3):63-67.
[20]Wijeysundera D N,Naik J S,Beattie W S.Alpha-2 adrenergic agonists to prevent perioperative cardiovascular complications:a meta-analysis[J].American Journal of Medicine,2003,114(9):742-752.
[2]周辉,李世忠,夏月峰.高龄病人的手术麻醉[J].现代医药卫生,2007,23(10):1500-1501.
[3]张丽敏,安辉,邓海峰,等.高龄患者PFNA手术麻醉方法的探讨[J].中国伤残医学,2011,19(5):51-52.
[4]陈顺富,祝贵州,陈忠华.高龄患者上腹部手术的麻醉方法探讨[J].江西医药,2006,41(2):107-109.
[5]王莉,侯锐,胡开进.ASA分级系统在口腔外科门诊治疗中的应用[J].实用口腔医学杂志,2012,28(1):51-54.
[6]程莉莉,李洋,郑文慧,等.不同体位发音时评估Mallampati分级结果与改良Cormach-Lehane分级相关性研究[J].中国医科大学学报,2015,44(8):699-703.
[7]Kim S Y,Kim J M,Lee J H,et al.Efficacy of intraoperative dexmedetomidine infusion on emergence agitation and quality of recovery after nasal surgery[J].British Journal of Anaesthesia,2013,111(2):222-228.
[8]左四琴,王艳.基于Riker镇静躁动评分的护理对神经外科ICU躁动患者并发症的影响[J].中华现代护理杂志,2014,20(11):1316-1318.
[9]杨荣宽.老年全麻手术苏醒期患者躁动发生状况及其危险因素[J].实用临床医药杂志,2016,20(1):163-165.
[10]刘金虎.老年患者全身麻醉术后苏醒期躁动的logistic回归分析[J].中国实验诊断学,2016,20(12):2030-2033.
[11]王灿经.影响全麻苏醒期老年患者躁动的危险因素调查[J].中国现代医生,2012,50(6):14-15.
[12]Yang L,Ying Z,Da-Li W,et al.Risk factors for acquired pneumonia in patients after tracheal intubation under general anesthesia and prevention measures[J].Chinese Journal of Nosocomiology,2013,23(19):4673-4674.
[13]Mayer J,Boldt J,R?hm K D,et al.Desflurane anesthesia after sevoflurane inhaled induction reduces severity of emergence agitation in children undergoing minor ear-nose-throat surgery compared with sevoflurane induction and maintenance[J].Anesthesia&Analgesia,2006,102(2):400-404.
[14]贾俊香,姚向国,梁小玲.右美托咪定预防小儿全身麻醉苏醒期躁动临床效果观察[J].齐齐哈尔医学院学报,2014,35(23):3448-3449.
[15]李定鲲.不同麻醉方式对老年患者术后麻醉恢复期的影响[J].临床合理用药杂志,2014,7(10):159.
[16]钱晓岚,任莹莹,王琦英,等.盐酸右美托咪定的药理作用及临床应用[J].临床研究,2016,24(8):201-202.
[17]张青,王竹梅.右美托咪啶的药理作用及临床应用进展[J].贵州医药,2016,28(5):544-547.
[18]Kumari R,Kumar A,Kumar S,et al.Intravenous dexmedetomidine as an adjunct to subarachnoid block:a simple effective method of better perioperative efficacy[J].Journal of Anaesthesiology Clinical Pharmacology,2017,33(2):203-208.
[19]Koroglu A,Teksan H,Sagir O,et al.A comparison of the sedative,hemodynamic,and respiratory effects of dexmedetomidine and propofol in children undergoing magnetic resonance imaging[J].Anesth Analg,2006,5(3):63-67.
[20]Wijeysundera D N,Naik J S,Beattie W S.Alpha-2 adrenergic agonists to prevent perioperative cardiovascular complications:a meta-analysis[J].American Journal of Medicine,2003,114(9):742-752.