| Objective:To study the sedative and hemodynamic effects of dexmedetomidine in the middle-aged and elderly patients undergoing orthopaedic lower extremity surgery,and to clarify the clinical application effect of dexmedetomidine in the middle-aged and elderly patients.Methods:from September 2018 to April 2019,60 patients undergoing lower extremity orthopedic surgery with epidural anesthesia were enrolled in our hospital.ASA ??? grade.According to age difference,they were divided into middle-aged group(45-64 years old)and old group(?65 years old).After the anesthesia effect was confirmed,the loading dose of dexmedetomidine was 0.8 ?g/kg by intravenous pump injection,and the infusion speed was changed to 0.5 ?g·kg-1·h-1 in 15 minutes.The SBP,HR and Ramsay scores at the beginning of medication(T1),5min(T2),15min(T3),30min(T4),60min(T5)and 90min(T6),and adverse reactions were observed and recorded during the administration of dexmedetomidine.When the blood pressure was lower than 30%of the patient's basic blood pressure,5mg ephedrine hydrochloride was given for Symptomatic treatment;when the heart rate was lower than 50 times/min,0.5mg atropine was given for Symptomatic treatment;when the blood pressure was higher than 30%of the patient's basic blood pressure,0.25mg nitroglycerin was given.Results:1.Comparison of SBP,HR and Ramsay scores of patients at different time in two groups.(1)During the loading dose period,there was no significant difference in the SBP,HR,Ramsay scores of patients at T1 and T2 in the two groups(P>0.05).(2)With the prolongation of infusion time,the blood pressure in the elderly group showed a downward trend.The SBP of the elderly group at T3,T4,T5 and T6 was significantly decreased than that at the time of T1 and T2(P<0.05).Compared with the middle-aged group at the same time,the SBP of the elderly group was significantly lower at T4,T5 and T6(P<0.05).In the middle-aged group,the of SBP of T2,T3 T4,T5 and T6 were no significant difference compared with T1(P>0.05).(3)The heart rate of the elderly group showed a downward trend,compared with T1,the HR of the elderly group at the time of T3,T4,T5 and T6 was significantly decreased(P<0.05).Compared with the middle-aged group at the same time,the HR of the elderly group at T3,T4,T5 and T6 were decreased significantly(P<0.05).In the middle-aged group,compared with T1,the HR of T2,T3,T4 and T6 were no significant difference(P>0.05);but the HR of T5 was significant decreased than that in T1(P<0.05).(4)With the prolongation of infusion time,the Ramsay score of the elderly group showed an upward trend.The Ramsay scores of the elderly group at the time of T5 and T6 was higher than that in T1(P<0.05);the Ramsay scores at T3 and T4 were not statistically significant difference compared with T1(P>0.05).Compared with the middle-aged group at the same time,the Ramsay scores of T4,T5 and T6 in the elderly group were increased significantly(P<0.05).In the middle-aged group,there was statistically significant difference of the Ramsay scores at T5 and T6 compared with T1(P>0.05).2.Comparison of perioperative adverse reactions between the two groups(1)Compared with the elderly group the middle-aged group had a good sedative effect,and the total number of adverse reactions such as bradycardia and hypotension was significantly reduced(P<0.05).(2)The incidence of bradycardia in the elderly group was significantly higher than that in the middle-aged group(P<0.05).but the number of reactive hypertension in the middle-aged group was higher than that in the elderly group(P<0.05).(3)There was no shivering reaction in the two groups.There was no difference in the number of hypotension between the elderly group and the middle-aged group(P>0.05).Conclusion:Dexmedetomidine can be safely used in middle-aged patients with epidural anesthesia to assist sedation.However,dexmedetomidine has a deeper sedative effect in elderly patients with more adverse reactions,which may increase the risk of perioperative surgery.For the elderly patients,we should use it carefully,pay attention to the dosage and speed of infusion,and strengthen continuous monitoring to avoid hemodynamic changes and adverse reactions. |
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