右美托咪定对老年高血压患者围术期心肌影响作用.docVIP

右美托咪定对老年高血压患者围术期心肌影响作用 　　　【摘要】 目的 观察右美托咪定对老年高血压患者围术期心肌的保护作用。方法 择期行全髋置换手术的老年高血压患者30例,年龄gt;65岁,高血压Ⅱ级,随机分为右美托咪定(D组)和对照组(C组),每组15例。两组均采用静吸复合全身麻醉,诱导方式相同,D组在麻醉诱导前给予负荷剂量右美托咪定1 μg/kg,注射泵缓慢静脉注射,输注时间超过10 min,维持剂量以0.7 μg/(kg#8226;h)持续静脉注射。记录麻醉前、诱导后、气管插管后、拔管后即刻患者的血流动力学变化,同时在麻醉前、气管插管后、拔除气管导管后即刻三个时点记录患者心电图ST段水平。结果 两组患者麻醉诱导后心率、血压均明显下降(Plt;0.05或Plt;0.01);气管插管后、拔除气管导管后即刻,心率、收缩压、舒张压D组明显低于C组(Plt;0.05);气管插管后、拔除气管导管后即刻,ST段出现心肌缺血性改变,C组5例明显多于D组1例(Plt;0.05)。结论 静脉注射右美托咪定,能减轻老年高血压患者围术期心肌损伤,对心肌有一定保护作用。 　　【关键词】右美托咪定;高血压;心肌保护 　　【Abstract】 Objective To determine the effect of dexmedetomidine in elderly hypertension patients undergoing hip replacement surgery.Methods Thirty patients with hypertension of Ⅱdegree agedgt;65yr undergoing hip replacement surgery were randomly divided into dexmedetomidine group(D)and control group(C)with 15 cases each.Anesthesia induction and maintenance were same in two groups.In group D,dexmedetomidine 　　 　　was administered intravenously at 0.7 μg/(kg#8226;h)after a bolus infusion at 1 μg/(kg#8226;h)for 10 min.Changes of HR、SBP、DBP were monitored before anesthesia,after induction,intubation and extubation,The changes in ST segment were recorded before anesthesia,after intubation and immediately after extubation.Results HR、SBP、DBP decreased significantly after induction compared with that of before anesthesia in two groups(Plt;0.05,Plt;0.01)while group D were lower than that of group C after intubation and immediately after extubation.The cases ofST segment showing myocardial injury were significantly differences between group D and group C(5 VS 1)(Plt;0.05).Conclusion Dexmedetomidine intravenously could attenuate the degree of myocardial damage in elderly hypertension patients undergoing hip replacement surgery. 　　【Key words】 　　Dexmedetomidine; Hypertension; Myocardial protection 　　 　　老年高血压患者由于血管重构,全身小动脉粥样硬化,血管自身调节功能障碍等,在气管插管及手术创伤应激状态下易发生血压波动,引起重要脏器的严重并发症。研究表明,右美托咪定通过高选择性激动位于中枢神经系统及外周的α2肾上腺素能受体,降低交感神经活性,降低应激状态下异常增高的血压和心率,稳定血液动力学[1]。本研究采用随机对照方法,选择年龄gt;6