摘要
目的:探讨不同剂量右美托咪啶复合表面麻醉用于老年高血压患者白内障手术镇静、镇痛及控制循环的效果。方法:选择75例择期表麻下单眼超声乳化白内障摘除+人工晶体植入术的高血压患者,ASA分级I-Ⅲ级,年龄65~88岁,采用随机数字表法,将其分为3组:生理盐水组(C组)、不同剂量右美托咪啶组(D1组、D2组),每组25例。均采用微量注射泵静脉输注,输注时间15 min。D1组负荷量右美托咪啶(以生理盐水稀释至50 m L)1μg/kg,D2组0.7μg/kg,C组以等容量生理盐水替代。记录入室(T0)、手术开始时(T1)、白内障摘除时(T2)、手术结束时(T3)、出手术室时(T4)的5个时间点的心率(HR)、平均动脉压(MAP)、血氧饱和度(SPO2)和镇静评分(Ramsay)、镇痛评分(VRS)。记录手术医生满意度、患者满意度评分,患者术前及术后1 d焦虑评分(SAS),术中高血压等不良反应及心血管药物使用例数。结果:共71例患者纳入该研究。C组13例患者需使用乌拉地尔降压,4例艾司洛尔降心率,D1、D2组术中血压均降低,差异无统计学意义(P〉0.05),D1组有2例使用阿托品升心率。与C组比较,D1组、D2组的T2、T3、T4时点的HR降低(P〈0.05),与D2组比较,D1组HR下降更明显(P〈0.01)。D1组、D2组处于明显镇静状态,在T2、T3、T4时点,D1组较D2组镇静更为明显(P〈0.01),患者满意度评分D1组、D2组明显增加(P〈0.05)。但手术前后焦虑评分、镇痛评分无统计学差异(P〉0.05)。结论:缓慢泵注0.7μg/kg负荷量右美托咪啶,在老年术中高血压患者白内障手术中,具有较好的镇静及控制高血压、心率的效应,患者满意率高、安全性好。
AIM: To investigate the efficacy of different doses of dexmedetomidine combined with surface anesthesia for elderly patients with hypertension undergoing cataract surgery. METHODS: Seventy-five ASA Ⅰ-Ⅲ patients,aged 65 to 88 years,scheduled for cataract surgery were randomly divided into 3 groups( n = 25 each) by using a random number table: normal saline group( group C),different dexmedetomidine group( group D1,D2). 1μg /kg and 0. 7 μg /kg dexmedetomidine were infused intravenous by injection pump in D1 group and D2 group separately. The equal volume of normal saline was infused in group C. HR,MAP,SPO2,Ramsay and VRS were recorded during operating room( T0),at the operation beginning( T1),at cataract extraction( T2), at the end of surgery( T3) and at the leaving of operating room( T4).And surgeon satisfaction,patient satisfaction scores,preoperative and 1day postoperative patients ' SAS,adverse reactions such as intraoperative blood pressure and the information of cardiovascular drugs using were also recorded. RESULTS: A total of 71 patients were included in this study. 13 patients needed urapidil to control the blood pressure,and 4cases needed esmolol to decrease the heart rate in group C. Intraoperative blood pressure was lower in D1 and D2 group; there was no statistically significant difference( P〉0. 05) between the two groups.2 cases needed atropine to raise the heart rate in D1 group. HR at T2,T3 and T4 points in D1 and D2 group were lower than group C( P〈0. 05). Compared with D2 group,HR decreased significantly and sedation time was longer in D1 group( P〈0. 01). Compared with C group,patient satisfaction scores in D1 and D2 group increased significantly( P〈0. 05). But the SAS,either before or after operation,and VRS showed no difference between the three groups( P〉0. 05). CONCLUSION: 0. 7μg /kg load dosage of dexmedetomidine combined with surface anesthesia provide preferable sedation and stable haemodynamics for elderly pati
出处
《中国临床药理学与治疗学》
CAS
CSCD
2016年第9期1050-1054,共5页
Chinese Journal of Clinical Pharmacology and Therapeutics
关键词
右美托咪啶
老年人
高血压
白内障手术
dexmedetomidine
elderly patients
hypertension
cataract surgery