| 臧伟,曹建方,周晓敏.右美托咪定用于老年患者适度镇静时2种输注方式的临床效果比较[J].老年医学与保健,2025,31(6):1554-1559 |
| 右美托咪定用于老年患者适度镇静时2种输注方式的临床效果比较 |
| Comparison of clinical effects of two infusion methods of dexmedetomidine for moderate sedation in elderly patients |
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| DOI：10.3969/j.issn.1008-8296.2025.06.027 |
| 中文关键词: 老年 右美托咪定 适度镇静 靶控输注 均速输注 |
| 英文关键词: elderly dexmedetomidine moderate sedation target-controlled infusion constant-rate infusion |
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| 中文摘要: |
| 目的 比较右美托咪定(Dex)用于老年患者适度镇静时,靶控输注和均速输注 2 种方式的效果,为围术期使用Dex适度镇静方案提供临床参考数据.方法 选取 2022 年 6 月—2022 年 12 月苏州大学附属第二医院诊治的 60 例年龄＞65岁腰硬联合麻醉(CSEA)下行大隐静脉剥脱术的患者,随机分为靶控输注组(T组,n=30)和均速输注组(A组,n=30);T组以血浆效应部位浓度 0.7 ng/mL(Cino模型)进行靶控输注,A组以初始负荷剂量 0.4 μg/kg持续均速15 min泵注完,维持剂量为0.2～0.7 μg/kg/h.采集麻醉前(T0)、手术结束时(T3)的外周静脉血,检测血浆白介素-6(IL-6)和肿瘤坏死因子(TNF-α)血浆浓度、皮质醇(Cor)浓度,采用快速血糖仪检测血糖值;记录麻醉前(T0)、给药后30 min(T1)、手术结束前30 min(T2)、手术结束时(T3)的平均动脉压(MAP)、心率(HR)和血氧饱和度(SpO2),记录苏醒时间、Dex总用量、低血压和窦性心动过缓等不良事件发生率.结果 A组和T组T3 时IL-6、TNF-α、Cor和血糖浓度均较T0 时升高,且IL-6、Cor和血糖升高差异有统计学意义(P＜0.05);但 A组和 T 组间差异无统计学意义(P＞0.05).2 组T1、T2、T3 时MAP较T0 时显著下降,差异有统计学意义(P＜0.05);T1、T2 时,A组HR下降幅度大于T组(P＜0.05).T组Dex总用量少于A组,苏醒时间短于A组;T组窦性心动过缓发生率低于A组;差异均具有统计学意义(P＜0.05).结论 靶控输注和均速输注Dex用于老年患者,均能达到适度镇静状态,能有效抑制围术期应激指标的升高,但在Dex总用量、苏醒时间、减少不良反应方面,靶控输注方式更有优势. |
| 英文摘要: |
| Objective To compare the effects of target-controlled versus continuous infusion of dexmedetomidine(Dex)for moderate sedation in elderly patients and to provide clinical reference data for this sedation regimen during the perioperative period.Methods Sixty patients over 65 years old undergoing great saphenous vein stripping under CSEA were recruited from the Second Affiliated Hospital of Soochow University from June to December 2022.These patients were randomly assigned to Group T(target-controlled infusion,n=30)or Group A(fixed-rate infusion,n=30).Group T received dexmedetomidine via target-controlled infusion targeting a plasma effect-site concentration of 0.7 ng/mL(Cino model).Group A received an initial loading dose of 0.4 μg/kg administered at a constant rate over 15 minutes,followed by a maintenance infusion of 0.2-0.7 μg/kg/h.Peripheral venous blood samples were collected before anesthesia(T0)and at the end of surgery(T3)to measure plasma concentrations of interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α),cortisol(Cor),and blood glucose(measured with a rapid glucose meter).Mean arterial pressure(MAP),heart rate(HR),pulse oxygen Saturation(SpO2),recovery time,total Dex consumption,and the incidence of adverse events(e.g.,hypotension and sinus bradycardia)were recorded at the following time points:before anesthesia(T0),30 minutes after drug administration(T1),30 minutes before the end of surgery(T2),and at the end of surgery(T3).Results At T3,plasma levels of IL-6,TNF-α,Cor,and blood glucose were elevated from baseline(T0)in both groups.The increases in IL-6,Cor,and blood glucose were statistically significant(P＜0.05),with no significant differences observed between the groups(P＞0.05).Mean arterial pressure(MAP)was significantly lower at T1,T2,and T3 compared to T0 in both groups(P＜0.05).The decrease in heart rate(HR)at T1 and T2 was more pronounced in Group A than in Group T(P＜0.05).The total dosage of Dex administered was lower,and the recovery time was shorter in Group T than in Group A(P＜0.05).Additionally,the incidence of sinus bradycardia was lower in Group T(P＜0.05).Conclusion Both target-controlled and continuous infusion regimens of Dex are effective for achieving moderate sedation and attenuating perioperative stress responses in elderly patients.Nevertheless,the target-controlled infusion approach provides significant clinical benefits,including a reduced total Dex consumption,a quicker recovery profile,and a superior safety margin. |
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