不同剂量右美托咪定对老年高血压患者气管插管应激反应的影响
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篇名: 不同剂量右美托咪定对老年高血压患者气管插管应激反应的影响
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摘要: 目的:观察不同剂量右美托咪定对老年高血压患者气管插管应激反应的影响。方法:选取2014年6月-2016年5月我院收治的择期行气管插管全身麻醉的老年高血压患者105例,采用随机数字表法分为A、B、C组,各35例。3组患者均行全身麻醉,分别于插管前15 min经静脉泵泵入盐酸右美托咪定注射液0.3、0.6、1.0 μg/kg,同时均给予瑞芬太尼注射液0.5 μg/kg。给药10 min后,停止药物泵入,于纤维支气管镜引导下行清醒气管插管。观察3组患者入室后5 min(T1)、输注后即刻(T2)、插管后即刻(T3)、插管后1 min(T4)、插管后5 min(T5)的平均动脉压(MAP)、心率(HR)、脉博血氧饱和度(SpO2)和呼吸频率(RR),同时记录3组患者T3时Ramsay镇静评分、咳嗽评分、插管耐受性评分,并比较不良反应发生情况。结果:T1时点,3组患者MAP、HR、SpO2、RR水平比较,差异均无统计学意义(P>0.05)。T2时点,3组患者上述指标均显著降低,与T1时点比较差异均有统计学意义(P<0.05),组间比较差异均无统计学意义(P>0.05)。T3、T4、T5时点,3组患者MAP、HR、SpO2、RR水平均较T2时点显著升高,且A组患者MAP、HR水平显著高于B、C组,差异均有统计学意义(P<0.05);3组患者SpO2、RR水平组间比较,差异均无统计学意义(P>0.05)。T3时点,B、C组患者Ramsay镇静评分、咳嗽评分、插管耐受性评分均显著高于A组,差异均有统计学意义(P<0.05)。A组患者高血压、心动过速、呛咳、躁动的发生率明显高于B、C组,C组患者心动过缓、呼吸抑制的发生率明显高于A、B组,差异均有统计学意义(P<0.05)。结论:0.6 μg/kg和1.0 μg/kg的右美托咪定能有效抑制老年高血压患者气管插管时的应激反应,维持血流动力学的稳定,且0.6 μg/kg的右美托咪定不良反应的发生率相对较低。
ABSTRACT: OBJECTIVE: To observe the effects of different doses of dexmedetomidine on tracheal intubation stress response in elderly patients with hypertension. METHODS: A total of 105 elderly hypertensive patients who underwent selective general anesthesia with tracheal intubation were selected from our hospital during Jun. 2014-May 2016, and then divided into group A, B, C according to random number table, with 35 cases in each group. Three groups received general anesthesia, Dexmedetomidine injection 0.3, 0.6, 1.0 μg/kg by intravenous infusion and Remifentanil injection 0.5 μg/kg 15 min before intubation. After 10 min of administration, 3 groups stopped drug infusion and received tracheal intubation fiberoptic bronchoscope. Mean arterial pressure (MAP), heart rate (HR), blood pulse oxygen saturation (SpO2), respiratory rate (RR) were observed in 3 groups at 5 min after entering surgery room (T1), immediately after infusion (T2), immediately after intubation (T3), 1 min after intubation (T4), 5 min after intubation (T5). Ramsay sedation scores, cough scores and intubation tolerance scores were also recorded in 3 groups at T3, and the occurrence of ADR was compared among 3 groups. RESULTS: At T1, there was no statistical significance in MAP, HR, SpO2 or RR among 3 groups (P>0.05). At T2, above indexes of 3 groups were decreased significantly than at T1, with statistical significance (P<0.05); there was no statistical significance among 3 groups (P>0.05). At T3, T4 and T5, MAP, HR, SpO2 and RR of 3 groups were increased significantly than at T2, and MAP and HR of group A were significantly higher than those of group B and C, with statistical significance (P<0.05). There was no statistical significance in SpO2 or RR among 3 groups (P>0.05). At T3, Ramsay sedation scores, cough scores, intubation tolerance scores of group B and C were significantly higher than those of group A, with statistical significance (P<0.05). The incidence of hypertension, tachycardia, cough and restlessness in group A were significantly higher than group B and C (P<0.05), the incidence of bradycardia and respiratory depression in group C were significantly higher than group A and B, with statistical significance (P<0.05). CONCLUSIONS: Dexmedetomidine 0.6 μg/kg and 1.0 μg/kg can effectively inhibit stress response and maintain hemodynamics stable in elderly hypertensive patients during tracheal intubation, and dexmedetomidine 0.6 μg/kg has relatively lower incidence of ADR.
期刊: 2017年第28卷第29期
作者: 秦旭,王丹,汪文刚
AUTHORS: QIN Xu,WANG Dan,WANG Wengang
关键字: 右美托咪定;瑞芬太尼;老年;高血压;气管插管;应激反应
KEYWORDS: Dexmedetomidine; Remifentanil; Elderly; Hypertension; Tracheal intubation; Stress response
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