林丽田　彭惠华

【摘要】 目的：探讨右美托咪定联合丙泊酚对老年患者全身麻醉苏醒期躁动及血浆皮质醇水平的影响。方法：选取2016年1月-2017年10月本院择期全身麻醉下行骨科手术的老年患者60例作为研究对象，按照随机数字表法将其分为丙泊酚组（P组）和右美托咪定联合丙泊酚组（DP组），每组30例。DP组在麻醉诱导前给予右美托咪定0.5 ?g/kg（15 min），术中以0.2 ?g/（kg·h）持续输注至手术结束前5 min。两组均给予阿曲库铵0.7 mg/kg、丙泊酚1～3 mg/kg、舒芬太尼效应室靶控浓度0.2 ?g/kg诱导插管，术中通过调节丙泊酚靶控血浆浓度维持BIS值在45～55。观察比较两组各时间点的血浆皮质醇浓度、Riker镇静和躁动（Riker sedation-agitation scale，RSAS）评分及全身麻醉苏醒期躁动情况。结果：DP组RSAS评分和全身麻醉苏醒期躁动发生率均明显低于P组，差异均有统计学意义（P<0.05）。DP组T0、T1、T2、T3各时间点的血浆皮质醇浓度均明显低于P组，差异均有统计学意义（P<0.05）。结论：丙泊酚血浆靶控输注麻醉下应用右美托咪定可分别抑制与预防全身麻醉下行骨科手术的老年患者苏醒期应激反应和躁動。

【关键词】 右美托咪定; 丙泊酚; 老年学; 躁动; 皮质醇

【Abstract】 Objective：To discuss the effect of Dexmedetomidine combined with Propofol on agitation and plasma cortisol levels during general anesthesia recovery in elderly patients.Method：A total of 60 elderly patients who underwent selective surgeries of orthopedic surgery under general anesthesia in our hospital from January 2016 to October 2017 were selected as the study objects.According to the random number table method，they were divided into Propofol group（group P）and Dexmedetomidine group combined with Propofol group（group DP），30 cases in each group.DP group was given 0.5 ?g/kg（15 min）of Dexmedetomidine intravenously before induction of anesthesia，and 0.2 ?g/（kg·h）was continuously infused during operation until 5 min before the end of operation.Both groups were given Atracurium 0.7 mg/kg，Propofol 1-3 mg/kg and Sufentanil target-controlled concentration 0.2 ?g/kg to induce intubation.BIS value was maintained at 45-55 by adjusting Propofol target-controlled plasma concentration during operation.The plasma cortisol concentration at each time point，Riker sedation-agitation scale（RSAS）score and agitation during general anesthesia recovery between the two groups were observed and compared.Result：The RSAS score and incidence of agitation during general anesthesia recovery in group DP were significantly lower than those in group P，the differences were statistically significant（P<0.05）.The plasma cortisol concentration at T0，T1，T2 and T3 time points of group DP were significantly lower than those of group P，the differences were statistically significant（P<0.05）.Conclusion：The application of Dexmedetomidine under the plasma target-controlled infusion anesthesia with Propofol can inhibit and prevent the irritable response and agitation of the elderly patients undergoing orthopaedic surgery under general anesthesia respectively.

【Key words】 Dexmedetomidine; Propofol; Gerontology; Agitation; Cortisol