右美托咪定用于老年患者全身麻醉下行经尿道输尿管软镜钬激光碎石术的临床效果观察
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摘要
目的探讨老年患者全身麻醉下行经尿道输尿管软镜钬激光碎石术术中应用右美托咪定对血压、心率及应激反应的影响。方法入选病例为拟在全身麻醉下行经尿道输尿管软镜钬激光碎石术的老年患者,共40例,年龄区间为60～79岁,ASA分级为Ⅱ～Ⅲ级,将40例患者随机分为右美托咪定组(D组)和生理盐水组(C组),每组各20例。麻醉诱导前给予D组患者静脉泵入右美托咪定0. 5μg/kg,C组患者则同时给予等容量的生理盐水,观察给药前(T_0)、气管插管时(T_1)、手术开始时(T_2)、手术开始30 min(T_3)、拔管后(T_4)的MAP、HR并记录。检测T_0、T_1、T_4时间点血浆中肾上腺素(E)及去甲肾上腺素(NE)的血浆浓度。结果两组患者MAP、HR、血浆E及NE比较差异明显,有统计学意义(P <0. 05)。结论右美托咪定应用于全麻下老年患者经尿道输尿管软镜钬激光碎石术术中可有效维持术中心率和血压的稳定,减少应激反应。
Objective To investigate the effects of dexmedetomidine on stress reaction in elderly patients undergoing transurethral ureteroscope holmium laser lithotripsy with general anesthesia. Methods Forty elderly patients undergonging transurethral ureteroscope holmium laser lithotripsy with general anesthesia,they were aged 60 ～ 79,with ASAⅡ ～ Ⅲ and devided into Dex group( group D) and normal saline group( group C) randomly. Dexmedetomidine was given in group D with 0. 5 μg/kg and the equal volume of normal saline was infused in group C. MAP、HR were observed at the time before dexmedetomidine infusion( T_0),immediately after intubation( T_1),surgery beginning( T_2),30 min after the surgery beginning( T_3) and immediately after extubation( T_4). The plasma concentration of epinephrine( E)and norepinephrine( NE) were detected at T_0,T_1 and T_4. Results Compared with T_0,MAP at T_1～ T_4 in group D were decreased significantly( P < 0. 05) Conclusions The application of dexmedetomidine in the aged receiving transurethral ureteroscope holmium laser lithotripsy with general anesthesia could maintain stable hemodynamic index,decrease stress reaction.
Objective To investigate the effects of dexmedetomidine on stress reaction in elderly patients undergoing transurethral ureteroscope holmium laser lithotripsy with general anesthesia. Methods Forty elderly patients undergonging transurethral ureteroscope holmium laser lithotripsy with general anesthesia,they were aged 60 ～ 79,with ASAⅡ ～ Ⅲ and devided into Dex group( group D) and normal saline group( group C) randomly. Dexmedetomidine was given in group D with 0. 5 μg/kg and the equal volume of normal saline was infused in group C. MAP、HR were observed at the time before dexmedetomidine infusion( T_0),immediately after intubation( T_1),surgery beginning( T_2),30 min after the surgery beginning( T_3) and immediately after extubation( T_4). The plasma concentration of epinephrine( E)and norepinephrine( NE) were detected at T_0,T_1 and T_4. Results Compared with T_0,MAP at T_1～ T_4 in group D were decreased significantly( P < 0. 05) Conclusions The application of dexmedetomidine in the aged receiving transurethral ureteroscope holmium laser lithotripsy with general anesthesia could maintain stable hemodynamic index,decrease stress reaction.
引文
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[3] Talke PO,Lobo E,Brown R,et al. Systemically ad minis-tered a2-agonist-induced peripharal vasoconstrition in human. Anesthesiology,2003,99(1):65-70.
[4] Guler G,Akin A,Tosun Z,et al. Singel-dose dexnedetomidine attenuates airway and circulatory reflexes during extubation. Acta Anaesthesiol Scand,2005,49(8):1088-1091.
[5] El-Tahan MR,Mowafi HA,Al Sheikh IH,et al. Efficacy of dexmedetomidine in suppressing cardiovacular and homonal responses to general anaesthesia for caesarean delivery:a dose-response stydy. Int J Obstet Anesth,2012,21(3):222-229.