Narcotrend 监测下右美托咪定在老年患者全麻拔管期的应用

Application of dexmedetomidine in elderly patients during general anesthesia extubation guided by Narcotrend

摘要:

目的：观察老年患者麻醉脑电意识监测系统（Narcotrend）监测下泵注右美托咪定镇静，在全麻拔管期的心血管反应及并发症。方法：选择老年患者60例，随机平均分为右美托咪定（dexmedetomidine，DEX）组（DEX组）及对照组。DEX组：术毕前30 min予以DEX 0.5 μg/（kg·h）泵注，术毕调整其浓度使Narcotrend指数（narcotrend index，NI）值维持在65~79。对照组：术毕前30 min予以0.9%生理盐水0.125 ml/（kg·h）。记录各组患者入室（T1）、术毕（T2）、吸痰（T3）、拔管（T4）、拔管后5 min（T5）、拔管后10 min（T6）的收缩压（systolic blood pressure，SBP）、舒张压（diastolic blood pressure，DBP）、心率（heart rate，HR）及NI值，自主呼吸恢复、麻醉恢复室（post-anesthesia care unit，PACU）驻留时间及不良反应等。结果：2组T3、T4、T5时SBP、DBP、HR、NI值比较，差异有统计学意义（P﹤0.05）。对照组SBP、DBP、HR在T3、T4与T1比较，差异有统计学意义（P值均为0.000），2组自主呼吸恢复、PACU驻留时间差异无统计学意义（P=0.786，P=0.351），2组躁动发生率比较差异有统计学意义（P=0.024）。结论：对于老年患者术毕前30 min予以DEX 0.5 μg/（kg·h）泵注，术毕调整其浓度使NI值维持在65~79，在全麻拔管期可以维持其循环稳定及减少躁动，且不延长自主呼吸恢复及PACU驻留时间。

Abstract:

Objective：To observe the cardiovascular reactions and complications in elderly patients during general anesthesia extuba－tion after applying dexmedetomidine（DEX） guided by Narcotrend. Methods：Totally 60 elderly patients were randomly divided into DEX group and control group. DEX group：0.5 μg/（kg·h） Dex infusion was given at 30 min before finishing the surgery and narcotrend index（NI） was maintained at 65-79 by adjusting the concentration of DEX postoperatively. Control group：0.125 ml/（kg·h） 0.9% normal saline was given at 30 min before finishing the surgery. Systolic blood pressure（SBP），diastolic blood pressure（DBP），heart rate（HR） and NI values before the induction（T1），at the end of operation（T2），at tracheal suction（T3），at extubation（T4），5 min after the extubation（T5），10 min after the extubation（T6） were recorded. The spontaneous respiration recovery time，dwell time in PACU and complications were also recorded. Results：There were statistical differences in SBP，DBP，HR，NI values in T3，T4，T5 between two groups（P<0.05）. In control group，there were statistical difference in SBP，DBP，HR between T3，T4 and T1（all P=0.000）. There was no difference in the spontaneous respiration recovery time and dwell time in PACU between two groups（P=0.786，P=0.351）. There were statistical differences in the incidence of agitation between two groups（P=0.024）. Conclusion：Giving 0.5 μg/（kg·h） DEX infu－sion at 30 min before finishing the surgery and maintaining narcotrend index（NI） at 65-79 by adjusting the concentration of DEX postoperatively can maintain the stability of circulation and reduce the agitation without extending the spontaneous respiration recov－ery time and dwell time in PACU during general anesthesia extubation.