摘要
目的：评价右美托咪定用于腰-硬联合麻醉辅助镇静的效果及安全性。方法选择拟行子宫及双附件切除术患者90例，ASAⅠ～Ⅱ级，采用数字表法随机分为 A、B、C 三组，每组30例，选择 L2～3椎间隙行腰-硬联合麻醉，麻醉效果满意后静脉给予镇静药物。A 组给予右美托咪定0．5μg／kg，泵注10 min，继以0．5μg·kg^-1·h^-1持续泵注；B 组先静脉注射咪达唑仑0．06 mg／kg，继以0．04～0．20 mg·kg^-1·h^-1持续泵注；C 组先静脉注射丙泊酚0．5 mg／kg，注药时间60 s，继以0．3～1．2 mg·kg^-1·h^-1持续泵注；三组均调整药物剂量至患者 Ramsay 评分达3分，并维持手术全程。比较三组起效时间、苏醒时间、生命体征及镇静效果和不良反应等。结果 A 组起效时间[（11．2±2．8）min]长于 B 组[（6．4±2．4）min]和 C 组[（5．0±2．1）min]（t ＝7．12、9．70，均 P ＜0．05）；A、B 两组苏醒时间[（12．3±2．4）min、（13．8±2．5）min]长于 C 组[（7．4±2．3）min]（t ＝8．36、7．95，均 P ＜0．05）。在相同镇静深度下，A 组无呼吸抑制和下颌松弛患者出现，而 B、C 组分别有5例和6例出现呼吸抑制，有8例和9例出现下颌松弛；三组均出现不同程度的血压下降、心率减慢， A 组心率下降明显，术中30、60 min 和手术结束时心率显著低于其他两组（t ＝5．02、4．92，4．90、3．95，5．71、4．09，均 P ＜0．05），因心率减慢需给予阿托品治疗者分别为 A 组10例、B 组5例、C 组6例。结论右美托咪定与丙泊酚、咪达唑仑比较镇静效果好，呼吸抑制轻，用于腰-硬联合麻醉镇静是有效、可行的，但起效时间长，且容易引起患者心率减慢。
Objective To evaluate the efficacy and safety of dexmedetomidine aiding spinal -epidural anes-thesia for sedation.Methods Ninety ASAI -II female patients scheduled for elective spinal -epidural anesthesia were randomly divided into 3 groups（30 cases for each group）according to the digital table method.An epidural catheter was inseted at L2 -3 after satisfactory anesthesia,sedative drugs was intravenous.Group A received midazolam 0.05μg/kg initial loading dose for 10min and maintaining with 0.5μg·g^-1 ·h^-1 .Group B received midazolam 0.06μg/kg for 5min and maintaining with 0.5mg·g^-1 ·h^-1 .Group C received first intravenous injection of propo-fol 0.5 mg/kg,injection time 60s,maintaining with 0.3 -1.2mg·g^-1 ·h^-1 .The infusion rate was adjusted to increase or decrease in order to maintain the desired level of sedation（Ramsay score of 3）during operation.The seda-tion efficacy and adverse reactions of three groups were compared.Results The onset time[（11.2 ±2.8）min]in group A was longer than that of group B[（6.4 ±2.4）min],group C[（5.0 ±2.1）min]（t =7.12,9.70,all P 〈0.05）.The offset time of group A,B[（12.3 ±2.4）min,（13.8 ±2.5 ）min]were longer then those of group C [（7.4 ±2.3）min]（t =8.36,7.95,all P 〈0.05）.But 5 and 6 patients in the group B and C occurred hypoxia,and there were 8 and 9 patients developed partial airway obstruction due to relaxation of jaw muscle.At the time 30min, 60min and the end of surgery,the HR of the group A decreased deeply than the other two groups（t =5.02,4.92, 4.90,3.95,5.71,4.09,all P 〈0.05）,10,5,6 patients were given atropine for increasing the HR in the group A,B and C respectively.Conclusion Dexmedetomidine is more safe and effective for the sedation of spinal -epidural an-esthesia,compared with midazolam and propofol,but with lower HR and longer onset time.
作者
倪传宝
佟眷廷
殷志春
Ni Chuanbao Tong Chunting Yin Zhichun(Department of Anesthesiology, the People＇s Hospital of Jinhu County, Jiangsu 211600, China)
出处
《中国基层医药》
CAS
2016年第20期3155-3158,共4页
Chinese Journal of Primary Medicine and Pharmacy
