| The extraction of tracheal tube is the key step in the perioperative period.The stress response caused by extubation can cause heart rate,blood pressure in patients with dramatic changes in cycle parameters.Particularly in elderly patients,The function of the circulatory and respiratory decreased gradually with the growth of the age,and during general awakening period,due to external stimulus such as the sputum suction tube and the endotracheal tube,the stress response will be more intense,perioperative risk for serious organ damage will be increased significantly.Butorphanol,an opioid receptor agitating antagonist,has good analgesic effect and sedative effect,and can effectively prevent perioperative agitation in patients under general anesthesia.Dexmedetomidine has the unique pharmacological effects of inhibiting sympathy,maintaining the stability of cardiovascular system,and almost no respiratory depression.Foreign scholars have confirmed that dexmedetomidine combined with butorphanol can produce a good synergistic effect,and can reduce the amount of butorphanol.In this study,three different doses of butorphanol combined with dexmedetomidine were selected for elderly patients to observe the extubation stress response,and to explore the optimal dosage that can effectively inhibit extubation stress and has a low incidence of adverse reactions,so as to provide reference for clinical medication.Objective:To observe the effects of different doses of butorphanol combined with dexmedetomidine on extubation stress in elderly general anesthesia patients,and to explore the best dosage which can effectively inhibit extubation stress response and decrease the probability of the adverse events.Methods:One hundred and twenty elderly patients,aged 65-80,the American Society of Anesthesiologists(ASA)Ⅰ-Ⅱ,18kg/m~2≤BMI<28kg/m~2,according to the random number table,120 patients were divided into group A(Dexmedetomidine alone),group B1,group B2 and group B3(the united groups),with 30 patients in each group.Dosage regimen:group A:dexmedetomidine 0.3μg/kg and saline 5ml,group B1:dexmedetomidine 0.3μg/kg and butorphanol 10μg/kg,group B2:dexmedetomidine 0.3μg/kg and butorphanol 15μg/kg,group B3:dexmedetomidine 0.3μg/kg and butorphanol 20μg/kg (Note:dexmedetomidine was injected with a micropump 45min before the end of the surgery,and the infusion was completed in 15min. Immediately,the corresponding dose of butorphanol was diluted to 5ml intravenously).Obvervational index:(1)Heart rate(HR)and mean arterial pressure(MAP)were recorded before anesthesia induction(T0),at the end of surgery(T1),immediately after extubation(T2),5min after extubation(T3)and 15min after extubation(T4).(2)Arterial blood was extracted at the above time points and glucose(Glu)was measured using a quick glycemic meter.(3)Ramsay score and VAS score were recorded at T3,T4 and 2h after surgery(T5).(4)Resuscitation time,extubation time,cough score of extubation period and incidence of postoperative adverse events were recorded.Results:1.There were no statistically significant differences in age,body mass index,ASA grade and operation time among the four groups(P>0.05).2.At T0,there was no statistically statistical significance in MAP and HR among the four groups(P>0.05).From T1 to T4,MAP and HR of group B2 and group B3 were obviously lower than those of group A and group B1(P<0.05).Compared with T0,MAP and HR of group A and group B1 were obviously increased during T1-T3(P<0.05),while MAP and HR of group B2and group B3 were obviously decreased at T1 and T4(P<0.05).3.At T0,there was no statistically significant difference in Glu among the four groups(P>0.05).Compared with group A,Glu of group B1 was obviously decreased at T1 and T2,and Glu of group B2 and group B3 was obviously decreased during T1-T4(P<0.05).Compared with group B1,Glu of group B2 and B3 was obviously decreased during T2-T4(P<0.05).Compared with T0,Glu was obviously increased in group A during T1-T4 and in group B1 during T2-T4(P<0.05).4.Compared with group A and group B1,Ramsay scores of group B2and group B3 were obviously increased at T3 and T4,and VAS scores were obviously decreased during T3-T5(P<0.05).Ramsay score of group B3 was higher than that of group B2 at T3 and T4(P<0.05).5.The resuscitation time and extubation time of group B3 were obviously longer than those of the other three groups(P<0.05).Compared with group A and group B1,the cough scores of group B2 and group B3 were obviously lower(P<0.05).There was no statistically significant difference in the probability of nausea and vomiting among the four groups(P>0.05).The probability of somnolence in group B3 was obviously higher than that in the other three groups(P<0.05).Conclusion:15μg/kg butorfenol combined with 0.3μg/kg dexmedetomidine used before completion of surgery can safely and effectively inhibit extubation stress response in elderly general anesthesia patients,and the probability of adverse reactions such as respiratory depression,somnolence,nausea and vomiting is small. |
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