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右美托咪定在高血压病患者局麻眼科手术中的临床应用

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2013年第5期
页码:
543-546
栏目:
临床研究
出版日期:
2013-09-25

文章信息/Info

Title:
Clinical application of dexmedetomidine in patients with hypertension undergoing ophthalmologic surgery with local anesthesia
作者:
李 刚1; 毛 丽2; 任长和1; 吴刚明1; 王晓斌1
(泸州医学院附属医院：1.麻醉科，2.手术室，四川 泸州 646000)
Author(s):
LI Gang1;  MAO Li2;  REN Chang he1;  WU Gang ming1;  WANG Xiao bin1
(1.Department of Anesthesiology, 2.Operating Room, Affiliated Hospital, Luzhou Medical Collage, Luzhou 646000, Sichuan, China)
关键词:
右美托咪定; 高血压; 眼科手术; 局麻
Keywords:
dexmedetomidine;  hypertension;  ophthalmologic surgery;  local anesthesia
分类号:
R614.3
DOI:
-
文献标识码:
A
摘要:
目的:观察右美托咪定在高血压病患者局麻眼科手术中的临床应用效果。方法： 60例择期眼科手术的原发性高血压患者，随机分为右美托咪定组（试药组，n=30）和对照组（n=30）；右美托咪定组患者术前先经输液泵缓慢静脉注射盐酸右美托咪定05 μg/kg 负荷剂量，10 min泵完，然后以02 μg/(kg·h)速率持续泵注至术毕；对照组给予相同容量的生理盐水。两组患者均在局麻下完成眼科手术。记录两组患者麻醉前(T0)，注射局麻药时(T1)，手术30 min(T2)，术毕(T3)时无创袖带收缩压(SBP)、舒张压(DBP)、心率(HR)、脉搏血氧饱和度(SpO2)、呼吸频率(RR)、镇痛镇静评分及不良反应。结果： 在T1、T2、T3时点，试药组HR、SBP、DBP、RR、疼痛VAS评分均显著低于对照组（P<001）；而镇静Ramsay评分显著高于对照组（P<001）； 试药组与对照组各个时间点SpO2均保持在95%以上，未见明显统计学差异。试药组患者术中使用降压药乌拉地尔次数少于对照组，而术毕舒适度评分高于对照组（均P<001）。两组患者麻醉手术中恶心、呕吐、呼吸抑制等不良反应发生率未见统计学差异。结论： 小剂量右美托咪定用于高血压病患者的局麻眼科手术，可以有效减少术中血流动力学波动，镇静镇痛满意，患者舒适度高。
Abstract:
AIM:To investigate the clinical application of dexmedetomidine in hypertension patients undergoing ophthalmologic surgery with local anesthesia. METHODS: A total of 60 hypertensive patients undergoing elective ophthalmologic surgery were randomly divided into two groups (30 cases in each group): dexmedetomidine group (group D) and control group (group C). A loading dose of dexmedetomidine (05 μg/kg) was infused slowly for 10 min in group D by i.v. pump before surgery, and 02 μg/(kg·h) was then infused continuously until completion of the surgery. The same volume of saline was infused continuously until the end of surgery in group C. Surgery was carried out with local anesthesia in both groups. Systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate (HR), saturation of pulse oxygen (SpO2), respiratory rate (RR), score of sedation or analgesia and adverse reactions were recorded in both groups at the following time points: before anesthesia (T0), injection of anesthetics (T1), 30 min after initiation of surgery (T2), and at the end of surgery (T3). RESULTS: HR, SBP, DBP, RR and visual analogue score (VAS) in group D were significantly lower than those in group C at T1, T2 and T3 (P<001); however, Ramsay score in group D was significantly higher than in group C at T1, T2 and T3 (P<001). A significant difference in SpO2 was observed at no time points between groups. The use of urapidil was lower but the comfort score was higher in group D compared with group C. No significant difference in the incidence of nausea, vomiting, and respiratory inhibition was found between groups. CONCLUSION: Intravenous administration of lowdose dexmedetomidine could relieve pain in patients with hypertension undergoing ophthalmologic surgery with local anesthesia, reduce fluctuation of hemodynamics and achieve some sedative effects and a high level of comfort without respiratory inhibition. This method has value for clinical application.

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备注/Memo

备注/Memo:
收稿日期：2013-04-19.作者简介：李刚，主治医师，硕士 Email:lgfmmu631@163.com
更新日期/Last Update: 2013-09-30