作者：陈杰，王瑞桥，郭慧芳，张宁，周佩佩

单位：

056029河北省邯郸市，河北工程大学附属医院麻醉科 通信作者：陈杰，E-mail：278382205@qq.com

Units：

Department of Anesthesiology, Affiliated Hospital of Hebei Engineering University, Handan 056029, China Corresponding author: CHEN Jie, E-mail: 278382205@qq.com

关键词：

肺疾病,慢性阻塞性; 老年人; 右美托咪定; 瑞芬太尼; 麻醉,全身; 罗哌卡因; 镇痛,硬膜外; 治疗结果;

Keywords：

Pulmonary disease, chronic obstructive; Aged; Dexmedetomidine; Remifentanil; Anesthesia, general; Ropivacaine; Analgesia, epidural; Treatment outcome

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.231

Funds：

河北省医学科学研究重点课题（20180801）

摘要：

目的 探讨右美托咪定联合瑞芬太尼全身麻醉复合罗哌卡因硬膜外镇痛在老年慢性阻塞性肺疾病(COPD)患者中的应用效果。方法 选取2018年1月至2022年1月在河北工程大学附属医院行开胸手术的老年COPD患者100例为研究对象。采用随机数字表法将患者分为观察组和对照组，各50例。观察组采用右美托咪定联合瑞芬太尼全身麻醉复合罗哌卡因硬膜外镇痛，对照组采用瑞芬太尼全身麻醉复合罗哌卡因硬膜外镇痛。比较两组麻醉前(T0)、右美托咪定输注10 min(T1)、气管插管即刻(T2)、气管插管后5 min(T3)、手术结束即刻(T4)时血气分析指标〔动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)〕、血流动力学指标〔包括心率(HR)、平均动脉压(MAP)〕，术后30 min、6 h、1 d视觉模拟评分法(VAS)评分，术后30 min血压，治疗期间不良反应发生情况。结果 观察组T2、T4时PaO2高于对照组(P<0.05)。观察组T1、T2、T3、T4时HR、MAP低于对照组(P<0.05)。观察组术后30 min、6 h、1 d VAS评分低于对照组(P<0.05)。观察组术后30 min收缩压、舒张压低于对照组(P<0.05)。观察组不良反应发生率低于对照组(P<0.05)。结论 右美托咪定联合瑞芬太尼全身麻醉复合罗哌卡因硬膜外镇痛可以减少手术麻醉操作对老年COPD患者血气分析指标的影响，同时镇静、镇痛作用明显，可减轻应激反应引起的血压波动，且安全性好。

Abstract：

【Abstract】　Objective To investigate the effect of dexmedetomidine combined with remifentanil general anesthesia combined with ropivacaine epidural analgesia in elderly patients with chronic obstructive pulmonary disease (COPD) . Methods A total of 100 elderly COPD patients who underwent thoracotomy in Affiliated Hospital of Hebei Engineering University from January 2018 to January 2022 were selected as the research subjects. The patients were divided into observation group and control group by random number table method, 50 cases in each group. The observation group was given dexmedetomidine combined with remifentanil general anesthesia combined with ropivacaine epidural analgesia, and the control group was given remifentanil general anesthesia combined with ropivacaine epidural analgesia. The blood gas analysis indexes [arterial partial pressure of carbon dioxide (PaCO2) , arterial partial pressure of oxygen (PaO2) ] and hemodynamics indexes [heart rate (HR) , mean arterial pressure (MAP) ] before anesthesia (T0) , 10 minutes after dexmedetomidine infusion (T1) , immediately after endotracheal intubation (T2) , 5 minutes after endotracheal intubation (T3) , and immediately after operation (T4) , visual analogue scale (VAS) score at 30 minutes after operation, 6 hours after operation and 1 day after operation, blood pressure at 30 minutes after operation, and adverse reactions during treatment were compared between the two groups. Results PaO 2 in the observation group was higher than that in the control group at T2 and T4 (P < 0.05) . HR and MAP at T1, T2, T3, and T4 in the observation group were lower than those in the control group (P < 0.05) . The VAS scores of the observation group at 30 min, 6 h and 1 d after operation were lower than those of the control group (P < 0.05) . The systolic blood pressure and diastolic blood pressure at 30 minutes after operation in the observation group were lower than those in the control group (P < 0.05) . The incidence of adverse reactions in the observation group was lower than that in the control group (P < 0.05) . Conclusion Dexmedetomidine combined with remifentanil general anesthesia combined with ropivacaine epidural analgesia can reduce the impact of surgical anesthesia on blood gas analysis indicators in elderly COPD patients. At the same time, it has obvious sedative and analgesic effects, can reduce blood pressure fluctuations caused by stress reactions, and has good safety.

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