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中国人民解放军总医院
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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
100853, 北京市复兴路28号
电话:010-66936756
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E-mail: zhlndqg@mode301.cn
创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
陈新凯,郑焕金,陈少霞.全身麻醉复合不同剂量右美托咪定持续输注对老年髋部骨折患者的影响[J].中华老年多器官疾病杂志,2019,18(9):674~677
全身麻醉复合不同剂量右美托咪定持续输注对老年髋部骨折患者的影响
Comparison of general anesthesia combined with continuous infusion of different dosed dexmedetomidine in the elderly with hip fracture
  
DOI:10.11915/j.issn.1671-5403.2019.09.146
中文关键词:  老年人;髋骨折;应激;血流动力学;右美托咪定
英文关键词:aged; hip fracture; stress; hemodynamics; dexmedetomidine
基金项目:
作者单位E-mail
陈新凯 汕头市潮阳区大峰医院麻醉科,汕头 515154 tv21889@163.com 
郑焕金 汕头市潮阳区大峰医院麻醉科,汕头 515154  
陈少霞 汕头市潮阳区大峰医院麻醉科,汕头 515154  
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中文摘要:
      目的 评价全身麻醉复合不同剂量右美托咪定持续输注对老年髋部骨折患者的影响。方法 入选2018年1月至12月汕头市潮阳区大峰医院麻醉科老年髋部骨折患者99例,随机数表法分为右美托咪定低剂量组45例和高剂量组44例。低剂量组给予0.5μg/(kg·h)右美托咪定持续输注辅助麻醉,高剂量组给予1.0μg/(kg·h)右美托咪定持续输注辅助麻醉,比较2组患者拔管和苏醒时间,麻醉前(T0)、麻醉诱导后(T1)、右美托咪定输注15min 时(T2)和手术结束时(T3)各时间点的平均动脉压(MAP)和心率(HR),以及术前和术后2h应激反应指标水平。应用SPSS 18.0统计软件对数据进行分析。结果 低剂量组较高剂量组患者术后苏醒和拔管时间[(13.42±0.69)和(16.91±1.08)min;(20.17±2.46)和(27.63±3.02)min]短,差异有统计学意义(P<0.05)。相比T0,2组患者T1、T2、T3时间点MAP和HR均降低,差异有统计学意义(P<0.05)。2组患者T0、T1、T2和T3时间点MAP和HR差异均无统计学意义(P>0.05)。与术前相比,2组患者术后2h皮质醇[(189.24±23.76)和(153.48±20.57)μg/L;(182.63±24.81)及(152.88±21.72)μg/L]和醛固酮[(49.21±8.62)和(33.76±5.80)pg/L;(47.29±4.02)和(34.07±3.97)pg/L]水平均升高,差异有统计学意义(P<0.05)。2组患者间术前和术后2h肾上腺素、皮质醇、去甲肾上腺素和醛固酮水平差异均无统计学意义(P>0.05)。结论 全麻复合高剂量与低剂量右美托咪定持续输注均可稳定老年髋部骨折患者血流动力学指标,但低剂量右美托咪定可缩短拔管和苏醒时间。
英文摘要:
      Objective To investigate the effect of general anesthesia combined with continuous infusion of different doses of dexmedetomidine on elderly patients with hip fracture. Methods From January to December 2018,9 elderly patients with hip fracture admitted in our hospital were enrolled in this study. They were randomly divided into low-dose dexmedetomidine group (n=45) and high-dose group (n=44). Continuous infusion of dexmedetomidine as adjuvant anesthesia was given at 0.5μg/(kg·h) for the patients in the low-dose group, and at 1.0μg/(kg·h) for those in the high-dose group. The extubation and recovery time, mean arterial pressure (MAP) and heart rate (HR) at pre-anesthesia (T0), post-anesthesia induction (T1), after infusion of dexmedetomidine for 15min (T2) and end of operation (T3), as well as the levels of pre- and post-operative stress response indicators were compared between the 2 groups. SPSS statistics 18.0 was used for data analysis. Results The recovery time [(13.42±0.69) vs (16.91±1.08)min] and extubation time [(20.17±2.46) vs (27.63±3.02)min] were significantly shorter in the low-dose group than the high-dose group (P<0.05). Compared with the levels at T0, MAP and HR at T1, T2 and T3 time points were obviously decreased in both groups (P<0.05). There was no differences in the 2 indicators at the above time points between the 2 groups (P>0.05). The levels of cortisol [(189.24±23.76) vs (153.48±20.57)μg/L; (182.63±24.81) vs (152.88±21.72)μg/L] and aldosterone [(49.21±8.62) vs (33.76±5.80)pg/L; (47.29±4.02) vs (34.07±3.97)pg/L] at 2h after operation were notably higher than those before operation in the 2 groups (P<0.05). But no differences were found in the levels of adrenaline, cortisol, noradrenaline and aldosterone between the 2 groups before and 2h after operation (P>0.05). Conclusion Continuous infusion of high and low dose dexmedetomidine combined with general anesthesia can stabilize hemodynamic indicators in the elderly patients with hip fracture, but low dose can shorten the extubation time and recovery time.
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