右美托咪啶在老年患者经尿道前列腺电切术中的应用

摘要

Objective To observe the safety of dexmedetomidine and whether it could reduce the side effects on senile patients undergoing transurethral resection of prostate(TURP). Methods Forty senile patients, ASA I or II, undergoing TURP were randomly divided into two groups:control group (C group)and dexmedetemidine group(D group) ,with 20 persons each. All persons received subarachnoid block anesthesia. 10 minutes after spinal anesthesia, dexmedetomidine 0. 5 μg/kg was given to D group as a bolus dosage in 10 minutes,followed by continuous infusion at a dose of 0. 2 μg/(kg · h). The same dose of physiological saline was given to C group. Heart rate(HR) , mean arterial pressure( MAP) ,respiratory(RR) ,oxygen saturation (SPO2) and the scores of alertness/sedation ( OAA/S) scale were recorded at the time points of preanesthesia (TO) , 10 minutes after spinal anesthesia(T1) , 10 minutes after Dex or saline infusion (T2) , the beginning of surgery(13) , 30 minutes after operation (T4) and the end of surgery (T5). Also the side effects of patients in two groups were recorded and the degree of comfort was evaluated. Results In D group, compared with the baseline, MAP decreased at T3-T5, HR decreased at T2-T5, RR decreased at T2-T4,and OAA/S decreased at T2-T5. In C group, compared with the baseline, RR decreased at T4-T5 (P<0. 05). Compared with C group, in D group, MAP decreased at T3-T5.HR decreased at T2-T5, RR decreased at T3 ,and OAA/S decreased at T2-T5. The incidence of shivering significantly also reduced while the score of comfort level increased in D group ( P < 0. 05). Conclusions Dexmedetomidine is not only safe and effective for the patients undergoing TURP, but also can decrease the incidence of side effects and improve the comfort level.%目的 观察右美托咪啶(DEX)应用于老年患者经尿道前列腺电切术(TURP)的安全性及是否降低围术期不良反应发生率. 方法 选择美国麻醉医师学会(ASA)分级Ⅰ～Ⅱ级,择期行TURP老年患者40例,随机分成2组,每组20例,行蛛网膜下腔阻滞麻醉.试验组(A组)于腰麻成功后10 min初始泵入0.5μg/kg DEX10 min),后以0.2μg/( kg·h)维持,手术结束时停止泵入；对照组(B组)给予同等剂量生理盐水.观察入室时(T0)、腰麻后10 min(T1)、DEX或生理盐水泵入后10 min(T2),手术开始时(I3),手术开始后30 min(T4)、手术结束时(T5)的心率(HR)、平均动脉压(MAP)、呼吸频率(RR)、脉搏血氧饱和度(SPO2)、警觉/镇静(OAA/S)评分及术中、术后不良反应发生率.评价患者的舒适度. 结果 与T0时间点比较,A组T3～T5时间点MAP降低,T2～T5时间点HR降低,T2～T4时间点RR降低,T2～T5时间点OAA/S评分降低；B组在T4～T5时间点RR降低(P＜0.05).与B组比较,A组在T3～T5时间点MAP降低,T2～T5时间点HR降低,T3时间点RR降低,T2 ～T5时间点OAA/S评分降低；寒战反应发生率降低；舒适度评分明显提高(P＜0.05). 结论 DEX应用于TURP术安全有效,可减少不良反应发生率,提高患者舒适度.