脑电双频指数监测下右美托咪定用于老年患者术中知晓的研究(1)
[摘要] 目的 研究在脑电双频指数监测下右美托咪定用于老年患者术中知晓的情况。 方法 选取择期行股骨干骨折切开复位内固定老年患者60例，随机分为右美托咪定组(D组)和咪达唑仑组(M组)，每组30例。记录两组给药后(T1)、气管插管后(T2)、手术开始后30 min(T3)、手术结束时(T4)的心率(HR)、收缩压(SBP)、舒张压(DBP)；在脑电双频谱保持同等状态下(50～60之间)比较术中丙泊酚维持用量和苏醒期躁动情况；术后第3天对患者问卷调查，评价术中知晓的发生。 结果 T2、T3、T4时D组较M组HR降低明显(P<0.05)，SBP、DBP均低于M组(P<0.05)；D组丙泊酚维持用量明显少于M组(P<0.05)，D组苏醒时躁动发生率明显低于M组(P<0.05)。 结论 右美托咪定复合麻醉可以维持血流动力学稳定，有效地避免术中知晓的发生，提高苏醒期质量。
[关键词] 右美托咪定；脑电双频指数；术中知晓
[中图分类号] R971+.2 [文献标识码] A [文章编号] 1674-4721(2015)02(b)-0074-03
Study of dexmedetomidine under monitoring of bispectral index on intraoperative awareness in elderly patients
DONG Xu XING Qun-zhi▲ HAN Xue-chang LU Yi-ping
Department of Anesthesia，the First Affiliated Hospital of Henan University of Science and Technology，Luoyang 471003，China
[Abstract] Objective To study dexmedetomidine under monitoring of bispectral index (BIS) on intraoperative awareness in elderly patients. Methods 60 elderly patients who would accept open reduction and internal fixation due to fracture of femoral shaft in a proper time were selected，and were evenly divided into dexmedetomidine group (group D) and midazolam group (group M) in random.Heart rate (HR)，systolic blood pressure (SBP)，and diastolic blood pressure (DBP) were recorded after medication (T1)，trachea cannula (T2)，30min of operation starting (T3)，and operation ending (T4).Dosage maintaining of propofol in operation and dysphoria during analepsia in the two groups were compared under the same condition of BIS (50～60).Questionnaires were distributed to these participants in the third day after surgery in order to evaluate the occurrence of intraoperative awareness. Results The HR in group D at T2，T3，and T4 decreased more obviously than that in group M (P<0.05).SBP and DBP in group D was lower than that in group M (P<0.05).In group D，dosage maintaining of propofol was less than that in group M (P<0.05).Frequency of dysphoria occurring during analepsia in group D was also greatly less than that in group M (P<0.05). Conclusion Dexmedetomidine combined with anesthetics can maintain stabilization of hemodynamics，effectively avoid the occurrence of intraoperative awareness，and improve patient′s quality during recovery period.
[Key words] Dexmedetomidine；Bispectral index；Intraoperative awareness
右美托咪定为美托咪定的活性右旋异构体，具有抗交感、镇静和镇痛的作用[1]，右美托咪定作为一种新的镇静药[2]应用于临床已经被证实可减少术中其他药物的用量，但在减少药物用量的同时，是否发生术中知晓尚未可知，本研究探讨脑电双频指数(bispectral index，BIS)监测下应用右美托咪定麻醉时老年患者术中知晓的情况。 (董旭 邢群智 韩学昌 逯益平)
[关键词] 右美托咪定；脑电双频指数；术中知晓
[中图分类号] R971+.2 [文献标识码] A [文章编号] 1674-4721(2015)02(b)-0074-03
Study of dexmedetomidine under monitoring of bispectral index on intraoperative awareness in elderly patients
DONG Xu XING Qun-zhi▲ HAN Xue-chang LU Yi-ping
Department of Anesthesia，the First Affiliated Hospital of Henan University of Science and Technology，Luoyang 471003，China
[Abstract] Objective To study dexmedetomidine under monitoring of bispectral index (BIS) on intraoperative awareness in elderly patients. Methods 60 elderly patients who would accept open reduction and internal fixation due to fracture of femoral shaft in a proper time were selected，and were evenly divided into dexmedetomidine group (group D) and midazolam group (group M) in random.Heart rate (HR)，systolic blood pressure (SBP)，and diastolic blood pressure (DBP) were recorded after medication (T1)，trachea cannula (T2)，30min of operation starting (T3)，and operation ending (T4).Dosage maintaining of propofol in operation and dysphoria during analepsia in the two groups were compared under the same condition of BIS (50～60).Questionnaires were distributed to these participants in the third day after surgery in order to evaluate the occurrence of intraoperative awareness. Results The HR in group D at T2，T3，and T4 decreased more obviously than that in group M (P<0.05).SBP and DBP in group D was lower than that in group M (P<0.05).In group D，dosage maintaining of propofol was less than that in group M (P<0.05).Frequency of dysphoria occurring during analepsia in group D was also greatly less than that in group M (P<0.05). Conclusion Dexmedetomidine combined with anesthetics can maintain stabilization of hemodynamics，effectively avoid the occurrence of intraoperative awareness，and improve patient′s quality during recovery period.
[Key words] Dexmedetomidine；Bispectral index；Intraoperative awareness
右美托咪定为美托咪定的活性右旋异构体，具有抗交感、镇静和镇痛的作用[1]，右美托咪定作为一种新的镇静药[2]应用于临床已经被证实可减少术中其他药物的用量，但在减少药物用量的同时，是否发生术中知晓尚未可知，本研究探讨脑电双频指数(bispectral index，BIS)监测下应用右美托咪定麻醉时老年患者术中知晓的情况。 (董旭 邢群智 韩学昌 逯益平)