摘要
目的：探讨右美托咪定复合七氟烷对老年患者术后苏醒质量的影响。方法将择期拟行经腹直肠癌切除术的老年患者60例，ASA分级Ⅰ或Ⅱ级，采用随机数字表法分为两组，每组30例：对照组（ N组）、右美托咪定组（ D组）。麻醉诱导开始前D组静脉微泵注射（大于10 min）右美托咪定1μg／kg（用0．9％氯化钠注射液配制成4μg／mL），然后予右美托咪定0．5μg＆#183; kg－1＆#183; h－1维持，N组微泵推注等容量0．9％氯化钠注射液。两组麻醉方法相同，均采用静吸复合全麻。观察记录患者麻醉诱导前（T0），给予右美托咪定（Ti）、插管后1 min（T1）、5 min（T2）、拔管即刻（T3）、拔管后5 min（T4）、30 min（T5）时间点的HR、BP、SpO2、BIS；记录丙泊酚和瑞芬太尼用量、手术时间、手术时间、麻醉时间、苏醒时间、拔管时间、拔管后Ramsay镇静程度评分、疼痛程度评分、患者满意度及不良反应。结果 T3时N组的HR（82±14）次／min、SBP（130±8） mmHg、DBP （85±13）mmHg的变化较D组[HR（70±12）次／min、SBP（121±7）mmHg、DBP（79±9）mmHg]更为明显，组间差异均有统计学意义（t＝6．28、4．63、2．08，均P＜0．05）。 T5时D组血糖（5．3±1．1）mmol／L、皮质醇（402±78）nmol／L、IL-6（0．260±0．044） ng／L 指标明显低于 N 组[血糖（5．9±1．2） mmol／L，皮质醇（550±92）nmol／L，IL-6（0．300±0．066）ng／L]，差异均有统计学意义（t＝2．02、6．72、2．76，均P＜0．05）。但是D组患者呼吸恢复时间（7．5±2．3）min、呼之睁眼时间（15．2±3．8）min、拔出气管导管时间（14．2±3．3）min与N组患者[呼吸恢复时间（7．8±2．5）min、呼之睁眼时间（14．8±3．2）min、拔出气管导管时间（13．9±3．1）min]差异均无统计学意义（ t＝0．88、0．44、0．36，均P＞0．05）。 N组患者术后发生躁动8例、恶心呕吐10例、寒战9例，发生率要高于D组的2例、2例、2例，差异均有统计学意义（χ2＝4．32、6．67、5．45，均P＜0．05），同时在T5时的D组患者满意度评分为（3．0±0．3）分，高于N组的（2．7±0．5）分，差异有统计学意义（t＝1．88，P＜0．05）。结论右美托咪定复合七氟烷麻醉可以提高老年患者直肠癌根治术术后苏醒质量。
Objective To investigate the effects of dexmedetomidine combined with sevoflurane on elderly patients with postoperative recovery quality.Methods Selected 60 cases of abdominal rectal cancer resection for elderly patients,which were ASA I or II,were randomly divided into two groups by a random number table method, while each groupincluded 30 cases：the control group（ group N） and the dexmedetomidine group（ group D） .Before the induction of anesthesia,group D vein was injected with micro pump （ more than 10 min） of dexmedetomidine 1μg/kg （ which was formulated with physiological saline as 4μg/mL） ,and then was given to maintain the dexmedetomidine 0.5μg/h and N group was injected with micro pump of the same volume of normal saline.The two groups of anesthesia were same,by which the static inhalation of composite general anesthesia.Observation were recorded before induction of anesthesia（T0）,given dexmedetomidine（TI）,after intubation 1 min（T1）,5 min（T2）,drawing tube immediately （T3）,extubation after 5min（T4）,30min（T5）the time of HR,BP,SpO2,BIS;propofol and remifentanil dosage,opera-tive time,operation time,a nesthesia time,recovery time,drawing tube time,extubation after Ramsay Sedation score, pain score,patient satisfaction and adverse reactions were recorded.Results In T3 period,the changes of HR （82 ± 14）times/min,SBP （130 ±8）mmHg,DBP （85 ±13）mmHg in group N were more obvious than （70 ±12）timse/min, SBP （121 ±7）mmHg,DBP （79 ±9）mmHg in group D,the difference between the two groups had statistical signifi-cance（t=6.28,4.63,2.08,all P〈0.05）.In T5 period,the levels of blood glucose （5.3 ±1.1）mmol/L and cortisol （402 ±78） nmol/L and （ 0.260 ±0.044 ） ng/L in group D were significantly lower than （ 5.9 ±1.2 ） mmol/L, （550 ±92）nmol/L,IL-6 （0.300 ±0.066）ng/L in group N（t=2.02,6.72,2.76,all P〈0.05）.However,the composite of dexmedetomidine group D patients with respiratory recovery time（7.5 ±2.3）min,calling the eyes open time（7.8 ±2.5） min,pull out the time of endotracheal tube （14.2 ±3.3） min compared with groups N of patients with respiratory recovery time （7.8 ±2.5）min,calling the eyes （14.8 ±3.2）min,pull out the time of endotracheal tube （13.9 ±3.1）min,showed no statistical significance （t=0.88,0.44,0.36,all P〉0.05）.In group N,postoper-ative restlessness in 8 cases,nausea and vomiting in 10 cases,chills in 9 cases,which were significantly higher than 2 cases,2 cases,2 cases in group D（χ2 =4.32,6.67,5.45,all P〈0.05）.At the same time,the satisfaction score of patient in group D （3.0 ±0.3）point,which was significant higher than （2.7 ±0.5）points in group N （t=1.88,P〈0.05）.Conclusion Dexmedetomidine detomidine composite sevoflurane anesthesia can improve the postoperative re-covery quality of elderly patients with rectal cancer radical surgery.
出处
《中国基层医药》
CAS
2015年第14期2092-2096,共5页
Chinese Journal of Primary Medicine and Pharmacy
基金
浙江省医学会临床科研资金项目（2012ZYC-A111）
浙江省医药卫生科技计划项目（2013KYA235）
浙江省丽水市科技计划项目（2012JYZB70）
关键词
直肠肿瘤
右美托咪定
七氟烷
老年人
Rectal Carcinoma
Dexmedetomidine
Seven halothane
Aged
