2020 年第 5 期 第 15 卷

小剂量右美托咪定滴鼻对全身麻醉下胃肠手术老年患者术后转归的影响

Effect of low-dose dexmedetomidine nasal drop on postoperative recovery in elderly patients undergoing general anesthesia

作者：谈世刚;鲁汉杰;殷国江;陈晓龙;阮剑辉;甘国胜;宋晓阳

英文作者：Tan Shigang Lu Hanjie Yin Guojiang Chen Xiaolong Ruan Jianhui Gan Guosheng Song Xiaoyang

单位：解放军中部战区总医院麻醉科，武汉430070

英文单位：Department of Anesthesiology Central Theater General Hospital of the Chinese People′s Liberation Army Wuhan 430070 China

关键词：胃肠手术；右美托咪定；滴鼻

英文关键词：Abdominalsurgery;Dexmetomidine;Nasaldrop

• 摘要：

• 目的 探讨全身麻醉下胃肠手术结束前小剂量右美托咪定滴鼻对老年患者术后转归的影响。方法 选择解放军中部战区总医院2018年3—12月行全身麻醉的老年胃肠手术患者60例，应用随机数字表法分为观察组和对照组，各30例，对照组手术结束前30 min停用肌肉松弛药后给予0.9%氯化钠注射液滴鼻；观察组手术结束前30 min停用肌肉松弛药后给予右美托咪定滴鼻。比较2组术中输液量、出血量、手术时间，手术不同时点收缩压、舒张压、心率水平，术后第1、2天疼痛视觉模拟量表评分，恢复期Ramsay镇静评分、躁动程度评分和不良反应发生率。结果 观察组术中输液量、出血量和手术时间与对照组比较差异均无统计学意义（均P>0.05）。对照组苏醒时和气管拔管即刻收缩压和舒张压明显高于滴鼻前，心率明显快于滴鼻前；观察组苏醒时和气管拔管即刻收缩压和舒张压明显低于对照组，心率慢于对照组，差异均有统计学意义（均P＜0.05）。与对照组比较，观察组恢复期Ramsay镇静评分高于对照组、躁动程度评分低于对照组［(2.1±0.8)分比（1.4±0.6）分、(0.6±0.5)分比（1.4±0.8）分］，术后第1天疼痛视觉模拟量表评分低于对照组［(2.8±0.7)分比（3.6±0.7）分］，差异均有统计学意义（均P＜0.05）。观察组恢复期恶心呕吐、呛咳、躁动、心动过速发生率均低于对照组［3.3%(1/30)比13.3%（4/30）、6.7%(2/30)比26.7%（8/30）、6.7%(2/30)比20.0%（6/30）、3.3%(1/30)比16.7%（5/30）］，差异均有统计学意义（均P＜0.05）。结论手术结束前30 min经鼻腔滴注0.5 μg/kg右美托咪定可以稳定全身麻醉下胃肠手术老年患者术后恢复期血流动力学，降低恢复期不良反应发生率，改善患者术后转归。

• Objective To observe the effect of low dose dexmetomidine nasal drops on the recovery of elderly patients after total hip arthroplasty. Methods Sixty elderly patients undergoing gastrointestinal surgery under general anesthesia admitted in Central Theater General Hospital of the Chinese People′s Liberation Army from March to December 2018 were divided into observation group and control，with  30 patients in each group. The control group were given intranasal drip of 0.9% sodium chloride injection 30 minutes before the end of operation and the observation group were given dexmetomidine nasal drops 30 minutes before the end of operation. Intraoperative infusion volume, bleeding volume, operation time and systolic blood pressure, diastolic blood pressure, heart rate at different time points were compared between the two groups. Visual analogue scale scores of pain on the 1st and 2nd day after operation, Ramsay sedation score, restlessness score and incidence of adverse reactions were compared between the two groups. Results There was no significant difference in intraoperative infusion volume, bleeding volume and operation time between the two groups (all P>0.05). The systolic and diastolic blood pressures of the control group were significantly higher than those of the T0 point at the time of awakening and extubation; the heart rate was significantly higher than that before nasal drip. The systolic and diastolic blood pressures of the observation group were significantly lower than those of the control group at the time of awakening and extubation;the heart rate was lower than that of the control group (P＜0.05). The Ramsay sedation score in the convalescent period in the observation group was higher than that in the control group; the restlessness score in the observation group was lower than that in the control group ［(2.1±0.8) vs (1.4±0.6), (0.6±0.5) vs (1.4±0.8)］. The VAS score in the first day after operation was lower than that in the control group ［(2.8±0.7) vs (3.6±0.7)］ (all P＜0.05). The incidence of nausea, vomiting, cough, restlessness and tachycardia in the convalescent period in the observation group were lower than those in the control group ［3.3%(1/30) vs 13.3%(4/30), 6.7%(2/30) vs 26.7%(8/30), 6.7%(2/30) vs 20.0%(6/30), 3.3%(1/30) vs 16.7%(5/30)］ (all P＜0.05). ConclusionNasal instillation of 0.5 μg/kg dexmedetomidine 30 min before the end of surgery can stabilize the hemodynamics of elderly patients with general anesthesia gastrointestinal surgery, reduce the incidence of adverse reactions during recovery and postoperative delirium; it can significantly improve the quality of postoperative recovery in elderly patients.