右美托咪定复合依托咪酯全麻对老年心脏手术患者脑氧代谢的影响

Cerebral Oxygen Metabolism Effects of Right Dexmedetomidine Combined with Etomidate Anesthesia for Elderly Patients

关键词:  右美托咪定  依托咪酯  全麻  老年人  脑氧代谢

Key words:  right dexmedetomidine  etomidate  anesthesia  elderly  cerebral oxygen metabolism

摘要:

目的 探讨右美托咪啶复合依托咪酯全麻对老年心脏手术患者脑氧代谢的影响。方法 体外循环下行心脏直视手术的老年患者50例根据随机数字表法分为实验组与对照组各25例，2组都采用全麻，实验组给予泵注右旋美托咪定麻醉诱导，对照组给予生理盐水进行麻醉诱导，2组都选择了依托咪酯进行镇静。所有患者于诱导前15 min(T1)、胸骨劈开后(T2)、体外循环开始后30 min(T3)、手术结束时(T4)进行脑氧代谢指标与血乳酸值的监测。结果 实验组的体外循环时间、主动脉阻断时间和手术时间明显少于对照组，差异有统计学意义(P<0.05)。实验组在T3与T4时刻点的静脉血乳酸值都明显低于对照组，差异有统计学意义(P<0.05)。2组在T3与T4时刻点的CaO₂和CvO₂值明显低于T1与T2时刻点(P<0.05)，2组在不同时间点的CaO₂和CvO₂值组间对比差异均无统计学意义。术后2组心包填塞、低氧血症、肺部感染、伤口感染等并发症发生率对比差异无统计学意义，所有并发症均对症处理后好转。结论 体外循环手术中用右美托咪定复合依托咪酯进行全麻处理后可加快手术的进度，降低患者体外循环的脑氧代谢水平与血乳酸值，保障了术后安全性。

Abstract:

OBJECTIVE To investigate cerebral oxygen metabolism effects of right dexmedetomidine combined with etomidate anesthesia for elderly patients. METHODS Fifty elderly patients by the cardiopulmonary bypass heart surgery based on the random number tab were equally divided into experimental group and control group, all cases were given the anesthesia, the experimental group were infused with dexmedetomidine pyridine before induction, and the control group were received saline for induction, both groups were selected etomidate sedation. RESULTS The cardiopulmonary bypass time, aortic clamping time and surgical time of experimental group were significantly less than the control group (P<0.05). The blood lactose of the experimental group were on the T3 and T4 time points were significantly lower than the control group (P<0.05). the CaO₂ and CvO₂ values in the two groups on the T3 and T4 time points were significantly lower than the T1 and T2 time points (P<0.05), between the values of the two groups compared had not statistically significant [15 min before induction (T1), after sternotomy (T2), after CPB started 30 min (T3), at the end of surgery (T4)]. After surgery, the incidences of cardiac tamponade, hypoxemia, pulmonary infection, wound infections and other complications compared between the two groups had no significant difference and were improved by the symptomatic treatment. CONCLUSION right dexmedetomidine combined with etomidate anesthesia for elderly patients with cardiopulmonary bypass surgery may facilitate the implementation and ease the cardiopulmonary bypass cerebral oxygen metabolism, thereby reduce blood lactate values and to protect the safety of surgery.