CAJ | 학술논문

目的评价右美托咪定对全麻老年患者脑氧代谢的影响.方法择期全麻下行腹部手术老年患者50例,年龄60～ 87岁,体重44～ 74 kg,ASA分级Ⅰ或Ⅱ级.采用随机数字表法分为2组(n=25):对照组(C组)和右美托咪定组(D组).D组于麻醉诱导前静脉泵注右美托咪定1.0μg/kg,输注时间20 min,C组给予等量生理盐水.于麻醉诱导前(T0)、气管插管后即刻(T1)、气管插管后10min(T2)及手术结束(T3)时经桡动脉、颈内静脉球部采集血样行血气分析,计算动脉-颈内静脉血氧含量差(Da-jvO2)和脑氧摄取率(CERO2).记录苏醒期躁动及术后谵妄的发生情况.结果与T0时比较,两组T1-3时Da-jvO2和CERO2降低(P＜0.05);与C组比较,D组T2-3时Da-jvO2和CERO2降低,苏醒期躁动和术后谵妄发生率减少(P＜0.05).结论右美托咪定可改善全麻老年患者的脑氧代谢,从而减少术后谵妄发生.
목적 평개우미탁미정대전마노년환자뇌양대사적영향.방법 택기전마하행복부수술노년환자50례,년령60～ 87세,체중44～ 74 kg,ASA분급Ⅰ혹Ⅱ급.채용수궤수자표법분위2조(n=25):대조조(C조)화우미탁미정조(D조).D조우마취유도전정맥빙주우미탁미정1.0μg/kg,수주시간20 min,C조급여등량생리염수.우마취유도전(T0)、기관삽관후즉각(T1)、기관삽관후10min(T2)급수술결속(T3)시경뇨동맥、경내정맥구부채집혈양행혈기분석,계산동맥-경내정맥혈양함량차(Da-jvO2)화뇌양섭취솔(CERO2).기록소성기조동급술후섬망적발생정황.결과 여T0시비교,량조T1-3시Da-jvO2화CERO2강저(P＜0.05);여C조비교,D조T2-3시Da-jvO2화CERO2강저,소성기조동화술후섬망발생솔감소(P＜0.05).결론 우미탁미정가개선전마노년환자적뇌양대사,종이감소술후섬망발생.
Objective To evaluate the effects of dexmedetomidine on the cerebral oxygen metabolism in elderly patients undergoing general anesthesia.Methods Sixty ASA physical status Ⅰ or Ⅱ patients,aged 60-87 yr,scheduled for elective abdominal surgery under general anesthesia,were randomly divided into 2 groups (n =25 each) using a random number table:control group (group C) and dexmedetomidine group (group D).Anesthesia was induced with iv injection of midazolam,fentanyl,atracurium and propofol.The patients were tracheally intubated and mechanically ventilated.In group D,dexmedetomidine 1.0μg/kg was infused intravenously over 20 min before induction of anesthesia,while the equal volume of normal saline was given in group C.Before induction of anesthesia,at 0 and 10 min after tracheal intubation and at the end of operation (T0-3),blood samples were taken from the radial artery and jugular bulb for blood gas analysis.Arteriovenous blood O2 content difference (DajvO2) and cerebral O2 extraction rate (CERO2) were calculated at the same time.The development of emergence agitation and postoperative delirium within 48 h after surgery were recorded.Resets Compared with the baseline values at T0,the Da-jvO2 and CERO2 were significantly decreased at T1-3 in the two groups (P ＜ 0.05).Compared with group C,the Da-jvO2 and CERO2 were significandy decreased at T2-3,and the incidence of emergence agitation and postoperative delirium within 48 h after surgery was decreased in group D (P ＜ 0.05).Conclusion Dexmedetomidine can improve the cerebral oxygen metabolism and reduce the development of postoperative delirium in elderly patients undergoing general anesthesia.