实用老年医学

实用老年医学 ›› 2022, Vol. 36 ›› Issue (3): 299-301.doi: 10.3969/j.issn.1003-9198.2022.03.022

• 临床研究 • 上一篇    下一篇

右美托咪定滴鼻对老年腹腔镜手术病人全麻拔管期应激反应的影响

邱立国, 时决振, 朱文宁, 曹小飞   

  1. 222300 江苏省连云港市,东海县人民医院麻醉科(邱立国,时决振,朱文宁);
    210029 江苏省南京市,南京医科大学第一附属医院麻醉与围术期医学科(曹小飞)
  • 收稿日期:2021-03-11 出版日期:2022-03-20 发布日期:2022-03-29
  • 通讯作者: 曹小飞,Email:xiaofei_cao@njmu.edu.cn

Effects of intranasal dexmedetomidine on extubation stress response during general anesthesia extubation in elderly patients after laparoscopic surgery

QIU Li-guo, SHI Jue-zhen, ZHU Wen-ning, CAO Xiao-fei   

  1. QIU Li-guo, SHI Jue-zhen, ZHU Wen-ning. Department of Anesthesiology, Donghai County People′s Hospital, Lianyungang 222300, China;
    CAO Xiao-fei. Department of Anesthesiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
  • Received:2021-03-11 Online:2022-03-20 Published:2022-03-29

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摘要： 目的 观察在老年病人腹腔镜术后拔管期予以不同剂量右美托咪定滴鼻的临床效果。方法 将80例择期行腹腔镜肾囊肿切除术的老年病人随机分为对照组以及不同剂量右美托咪定滴鼻组。分别于手术结束前30 min经鼻滴注右美托咪定0.5 μg/kg(低剂量组)、1 μg/kg(中剂量组)和1.5 μg/kg(高剂量组),对照组予以2 mL生理盐水滴鼻。分别记录手术结束时(T1)、拔管时(T2)、拔管后1 min(T3)、拔管后5 min(T4)、拔管后10 min(T5)各组病人心率(HR)和平均动脉压(MAP)。记录病人拔管时间、麻醉后监测治疗室(PACU)留观时间以及Ramsay评分。 结果 T1～T5时,低剂量组、中剂量组、高剂量组的MAP和HR较对照组明显降低(P<0.05);与低剂量组比较,中剂量组和高剂量组在T2～T5时HR明显减慢,T2～T3时MAP明显降低(P<0.05)。对照组、低剂量组和中剂量组的拔管时间及PACU留观时间均明显短于高剂量组(P<0.05)。低剂量组、中剂量组和高剂量组在T5时间点Ramsay评分明显高于对照组;但高剂量组病人仅对指令有反应(P<0.05)。 结论 腹腔镜肾囊肿切除术结束前30 min给予老年病人1 μg/kg右美托咪定滴鼻能有效抑制拔管期应激反应,同时不影响术后苏醒时间。

关键词: 右美托咪定滴鼻, 拔管期, 应激反应, 老年人

Abstract: Objective To observe the effects of different doses of intranasal dexmedetomidine on stress response during extubation in the elderly patients after laparoscopic surgery. Methods A total of 80 elderly patients with selective laparoscopic renal cystectomy were randomly divided into control group and intranasal dexmedetomidine groups with different doses. Low-dose group, middle-dose group and high-dose group received 0.5 μg/kg, 1 μg/kg and 1.5 μg/kg intranasal dexmedetoidine 30 min before the end of the operation respectively, and control group was given 2 mL intranasal 0.9% sodium chloride solution. Heart rate (HR) and mean arterial pressure (MAP) were recorded at the end of operation (T1), during extubation (T2), 1 min after extubation (T3), 5 min after extubation (T4), and 10 min after extubation (T5), respectively. Postoperative recovery indicators were recorded. Results Compared with control group, the level of MAP in intranasal dexmedetomidine groups decreased significantly and the level of HR decreased significantly at T1-T5 (P<0.05). Compared with low-dose group, the level of HR in middle-dose group and high-dose group decreased significantly at T2-T5, and the level of MAP decreased significantly at T2-T3 (P<0.05). The extubation time and post anesthesia intensive care unit (PACU) observation time in control group, low-dose group and middle-dose group were significantly shorter than those in high-dose group (P<0.05). Ramsay score in intranasal dexmedetomidine groups at T5 was significantly higher than that in control group. However, the patients in high-dose group only responded to instructions (P<0.05). Conclusions The administration of 1 μg/kg intranasal dexmedetomidine 30 min before the end of laparoscopic renal cystectomy in the elderly patients can effectively inhibit the stress response during periextubation without affecting the postoperative recovery time.

Key words: intranasal dexmedetomidine, extubation period, stress response, aged

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