右美托咪定聯(lián)合丙泊酚對老年患者全身麻醉蘇醒期躁動及血漿皮質醇水平的影響

林麗田　彭惠華

【摘要】 目的：探討右美托咪定聯(lián)合丙泊酚對老年患者全身麻醉蘇醒期躁動及血漿皮質醇水平的影響。方法：選取2016年1月-2017年10月本院擇期全身麻醉下行骨科手術的老年患者60例作為研究對象，按照隨機數(shù)字表法將其分為丙泊酚組（P組）和右美托咪定聯(lián)合丙泊酚組（DP組），每組30例。DP組在麻醉誘導前給予右美托咪定0.5 ?g/kg（15 min），術中以0.2 ?g/（kg·h）持續(xù)輸注至手術結束前5 min。兩組均給予阿曲庫銨0.7 mg/kg、丙泊酚1～3 mg/kg、舒芬太尼效應室靶控濃度0.2 ?g/kg誘導插管，術中通過調節(jié)丙泊酚靶控血漿濃度維持BIS值在45～55。觀察比較兩組各時間點的血漿皮質醇濃度、Riker鎮(zhèn)靜和躁動（Riker sedation-agitation scale，RSAS）評分及全身麻醉蘇醒期躁動情況。結果：DP組RSAS評分和全身麻醉蘇醒期躁動發(fā)生率均明顯低于P組，差異均有統(tǒng)計學意義（P<0.05）。DP組T0、T1、T2、T3各時間點的血漿皮質醇濃度均明顯低于P組，差異均有統(tǒng)計學意義（P<0.05）。結論：丙泊酚血漿靶控輸注麻醉下應用右美托咪定可分別抑制與預防全身麻醉下行骨科手術的老年患者蘇醒期應激反應和躁動。

【關鍵詞】 右美托咪定; 丙泊酚; 老年學; 躁動; 皮質醇

【Abstract】 Objective：To discuss the effect of Dexmedetomidine combined with Propofol on agitation and plasma cortisol levels during general anesthesia recovery in elderly patients.Method：A total of 60 elderly patients who underwent selective surgeries of orthopedic surgery under general anesthesia in our hospital from January 2016 to October 2017 were selected as the study objects.According to the random number table method，they were divided into Propofol group（group P）and Dexmedetomidine group combined with Propofol group（group DP），30 cases in each group.DP group was given 0.5 ?g/kg（15 min）of Dexmedetomidine intravenously before induction of anesthesia，and 0.2 ?g/（kg·h）was continuously infused during operation until 5 min before the end of operation.Both groups were given Atracurium 0.7 mg/kg，Propofol 1-3 mg/kg and Sufentanil target-controlled concentration 0.2 ?g/kg to induce intubation.BIS value was maintained at 45-55 by adjusting Propofol target-controlled plasma concentration during operation.The plasma cortisol concentration at each time point，Riker sedation-agitation scale（RSAS）score and agitation during general anesthesia recovery between the two groups were observed and compared.Result：The RSAS score and incidence of agitation during general anesthesia recovery in group DP were significantly lower than those in group P，the differences were statistically significant（P<0.05）.The plasma cortisol concentration at T0，T1，T2 and T3 time points of group DP were significantly lower than those of group P，the differences were statistically significant（P<0.05）.Conclusion：The application of Dexmedetomidine under the plasma target-controlled infusion anesthesia with Propofol can inhibit and prevent the irritable response and agitation of the elderly patients undergoing orthopaedic surgery under general anesthesia respectively.

【Key words】 Dexmedetomidine; Propofol; Gerontology; Agitation; Cortisol