Effects of different doses of dexemedetomidine on perioperative stress response in elderly patients undergoing laparoscopic gastrointestinal surgery / 临床麻醉学杂志

ABSTRACT

Objective To study the effects of different doses of dexemedetomidine on perioperative stress response in elderly patients undergoing laparoscopic gastrointestinal surgery.Methods Eighty ASA grade Ⅰ or Ⅱ elderly patients,aged≥65 years,falling into ASA Ⅰ or Ⅱ,undergoing laparoscopic gastrointestinal surgery,were randomly divided into four groupsgroup D1,D2,D3 and C,twenty cases in each.Dexmedetomidine was administrated with a loading dose of 0.5 μg/kg which was infused intravenously over 10 minutes before induction,and was infused intrave nously with a continuous dose of 0.2μg·kg-1 ·h-1,0.5μg·kg-1 ·h-1 and 0.8μg· kg-1 ·h-1 during operation respectively in group D1,D2,D3.In group C,patients were given 7 ml saline which was infused intravenously over 10 minutes before induction,and was infused with a continuous dose of 10 ml/h saline during operation.HR,SBP and DBP were recorded at before infusion (T0),immediately after intubation (T1),5 minutes after pneumoperitoneum (T2),1 hour after pneumoperitoneum (T3),immediately after extubation (T4),10 minutes after extubation (T5).The time of operation and the time of extubation were also recorded.Concentrations of Glu,Cor,E and NE were measured at T0,T1,T3,T5.Results The dosage of remifentanil in group D1,group D2 and group D3 was significantly lower than that in group C,and in group D2 and D3 was significantly lower than that in group D1 (P＜0.05).During T2-T5,HR of group D2 and group D3 was significantly slower than that of group C and group D1 (P＜0.05),and SBP of group D2 and group D3 was obviously lower than that of group C (P＜0.05),respectively.Compared with T0,HR of group C was significantly faster than that at T1-T5 (P＜0.05).Compared with group C,the concentrations of Glu,Cor,E and NE in group D2 and group D3 were extremely decreased (P＜0.05) at T3 and T5,and the concentrations of Cor and NE were obviously lower at T1 (P＜0.05).The concentrations of Cor and NE in group D2 and group D3 were remarkably lower than those in group D1 at T3 and T5 (P＜0.05).The extubation time of group D3 was apparently longer than that of group C (P ＜ 0.05).Conclusion Compared with continuous dose of 0.2 μg·kg-1 ·h-1 and 0.8 μg·kg-1 ·h-1 dexmedetomidine,dexmedetomidine infused intravenously at 0.5 μg· kg-1 · h-1 can more effectively inhibit perioperative stress responses of elderly patients undergoing laparoscopic gastrointestinal surgery,and maintain hemodynamic stability.