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右美托咪定对老年鼻内窥镜患者术后恢复和认知功能的影响
黄朝宇,陈素丽,郭涛,苏莉
0
(北京市海淀医院·北京大学第三医院海淀院区麻醉科;北京市航天中心医院麻醉科)
摘要:
【摘要】 目的 观察右美托咪定对全麻老年鼻内窥镜患者术后恢复和认知功能的影响。方法 选择在全麻下行鼻内窥镜手术老年患者60例,回顾性分析患者的临床资料,根据药物给予方法将其分为右美托咪定组(D组)30例和对照组(C组)30例。D组麻醉诱导前给予右美托咪定05ug/kg,然后以02~05ug/kg/h静脉持续泵入,手术结束前30min停药。C组以相同方法给予同等剂量的09%生理盐水。记录麻醉诱导前(T0)、气管插管完成即刻(T1)、 手术开始后1h(T2)、拔除气管导管即刻(T3),各个时间点的心率、 平均动脉压。术后苏醒情况(自主呼吸恢复时间、睁眼时间、 拔管时间),苏醒期的躁动情况,认知功能状况,不良反应情况。 结果 C组患者T1、T3时血压、心率明显高于T0(P<005),D组患者T1、T3时血压、心率与T0比较无显著差异(P>005)。T1~T3时C组血压、心率均明显高于D组(P<005)。两组患者自主呼吸恢复时间、睁眼时间、拔管时间比较无显著差异(P>005)。C组患者躁动发生率和SAS评分都明显高于D组(P<005)。两组患者麻醉诱导前未使用药物时其MMSE评分比较无差异(P>005),两组患者术后4h MMSE评分较术前明显降低,C组患者降低程度较D组更明显。两组患者不良反应发生率比较(667% vs 1333%)差异间无统计学意义(P>005),且均无明显严重不良反应发生。结论 麻醉诱导前15分钟给予右美托咪定05ug/kg,然后以02~05ug/kg/h静脉持续泵入,能有效减少鼻内窥镜手术老年患者血流动力学的波动,减轻病人术后躁动,不延长苏醒时间和拔管时间,不增加苏醒期并发症,可提高麻醉的安全性。
关键词:  躁动  麻醉苏醒期  鼻内窥镜手术  右美托咪定  血流动力学
DOI:
基金项目:北京大学第三医院海淀院区院级科研课题(KYQ2017006)
The Effect of dexmedetomidine on postoperative awakening and cognitive function in elderly patients undergoing endoscopic sinus surgery
HUANG Zhaoyu,CHEN Suli,GUO Tao,SU Li
(Department of Anesthesiology, Haidian Hospital;Department of Anesthesiology, Central Hospital of China Aerospace Corporation)
Abstract:
【Abstract】 Objective To investigate influence of dexmedetomidine on postoperative awakening and cognitive function in elderly patients undergoing endoscopic sinus surgery. Methods 60 elderly patients of selective endoscopic sinus surgery were selected in hospital from April to November in 2016 and randomly divided into experiment group (D group)and control group (C group).In D group, the patients received intravenous injection of DEX (05ug/kg) before anesthesia induction,and then received continuous injection of DEX at a rate of 0205ug/kg/h till 30 min before the operation finishing.In C group, physiological saline was used instead of DEX. Mean arterial blood pressure (MAP) and heart rate (HR) were determined before anesthesia (T0), during intubation (T1),1 hour after operation(T2),during extubation (T3). The postoperative awaken time,agitation during awaken period,cognitive function and adverse reactions were observed. Results Changes of HR and MAP in D group had no obvious fluctuation. In C group,HR and MAP increased significantly at T1,T3. HR and MAP at T1,T2,T3 in D group were significantly lower than C group. Two groups of patients with spontaneous breathing recovery time, awake time and extubation time were no significant difference (P>005). The incidence of agitation and SAS scores were significantly higher in C group than those in D group (P<005). Sedation score in D group was significantly higher than that in C group (P<005), there was no difference in MMSE score between the two groups before anesthesia induction (P> 005), and the degree of reduction in D group was more significant than that in C group.There was no significant difference in the incidence of adverse reactions between the two groups (667% vs 1333%) (P> 005), and there was no significant adverse reaction. Conclusion Using DEX in elderly patients of endoscopic sinus surgery, with preinjection 05ug/kg and continuous injection at a rate of 0205ug/kg/h till 30 min before the operation finishing, can effectively reduce hemodynamic fluctuations and reduce the incidence of agitation during recovery period and improve the safety of anesthesia,without the disadvantage of prolonging the recovery and extubation time.
Key words:  Agitation  Anesthesia recovery period  Endoscopic sinus surgery  Dexmedetomidine  Hemodynamic phenomena

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