目的 觀察右旋美托咪啶對硬膜外麻醉下老年高血壓患者的影響。方法 選取重慶市巴南區(qū)人民醫(yī)院2011年1月-2013年7月收治的70例行前列腺汽化切除術(shù)的老年原發(fā)性高血壓患者，隨機分成治療組（n=35）與對照組（n=35），治療組靜脈注射右旋美托咪啶0.4 μg/kg，對照組靜脈注射咪唑安定2 mg，兩組其他用藥完全一致。記錄入室時、給藥后5 min、麻醉后30 min、2 h患者血壓、心率及血氧飽和度，并對兩組進(jìn)行Ramsay鎮(zhèn)靜評分。結(jié)果 對照組給藥后5 min，血壓及心率較入室時上升明顯，治療組相對波動較小，兩組對比差異明顯（P<0.05），具有統(tǒng)計學(xué)意義。兩組血氧飽和度變化比較基本一致，沒有明顯差異。治療組不良反應(yīng)發(fā)生率約為20%，低于對照組（40%），兩組對比差異顯著（P<0.05）。結(jié)論 小劑量的右旋美托咪啶對老年高血壓患者有良好的鎮(zhèn)靜及中樞降壓作用，且不會產(chǎn)生呼吸抑制，維持圍術(shù)期生命體征穩(wěn)定。

Objective To observe the effect of Dexmedetomidine on elderly patients with hypertension under epidural anesthesia. Methods From January 2011 to July 2013, 70 elderly patients with essential hypertension, who were operated by vaporization resection of prostate in People's Hospital of Chongqing Banan, were randomly devided into treatment (n= 35) and control groups (n= 35). Patients in the treatment group received Dexmedetomidine 0.4 μg/kg by iv injection, while the patients in the control group received Midazolam 0.2 mg by iv injection. The other drugs were same used in the two groups. Blood pressure (mean aortic pressure, MAP), heart rate (HR), and blood oxygen saturation (SPO₂) at entering the operating room (before operation), 5 min after administration, 30 min, and 2 h after anesthesia were recorded. And Ramsay sedation score of the two groups were counted. Results AT5 min after administration, blood pressure and heart rate of the control group increased significantly compared with the baseline, patients in the treatment group had relatively small fluctuations, the differences were statistical significance (P < 0.05). There was no significant statistical difference in the blood oxygen saturation of the patients in the two groups. The adverse reaction in the treatment group was about 20%, lower than that of the control group (40%), with the significant difference between the two groups (P < 0.05).Conclusion A small dose of Dexmedetomidine has a good effect of sedation and central antihypertensive in elderly patients with hypertension, while has no respiratory depression during anesthesia, which could maintain stable vital signs.