右美托咪啶用于硬膜外麻醉时的镇静效果

目的 观察盐酸罗哌卡因硬膜外麻醉时静注右美托咪啶辅助镇静的有效性和安全性.方法 随机将60例择期盐酸罗哌卡因硬膜外麻醉下下腹部手术的患者分为两组:右美托咪啶组(D组,n=30)及对照组(C组,n=30).麻醉平面满意后两组分别静注右美托咪啶及0.9%氯化钠注射液并维持至术终.观察手术期间患者心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)、熵指数(RE)变化;观察患者手术期间及监护治疗室内心动过缓、低血压及腰背部疼痛等副反应和并发症的发生情况.结果 D组用药后15 min至停药后30 min 的HR均明显低于组内用药前及同时点C组,差异均有统计学意义(t分别= 2.73、4.23、5.01、4.56、3.92、4.25、3.12、2.89、4.24、3.78、2.92、3.29,P均＜0.05);D组用药后15 min至停药时RE均小于60,均明显低于组内用药前及同时点C组,差异均有统计学意义(t分别= 3.54、3.76、4.52、6.23、5.01、4.32、4.20、2.93、3.82、5.21、4.32、4.80,P均＜0.05);D组心动过缓发生率高于C组,寒战发生率低于C组,差异均有统计学意义(χ2分别=4.52、4.85,P均＜0.05).结论 盐酸罗哌卡因硬膜外麻醉时静注右美托咪啶,不仅镇静效果满意,而且可减少寒战发生,但可能导致心动过缓.

Effects of intravenous administration of dexmedetomidine on the sedative in hydrochloric ropivacaine peridural anesthesia

Objective To observe the efffects of intravenous administration of dexmedetomidine on the sedative in hy- drochloric ropivacaine peridural anesthesia. Methods Sixty patients （ASA Ⅰ -Ⅲ） scheduled for lower abdominal surgery undergoing hydrochloric ropivacaine peridural anesthesia were randomly divided into group D（n=30） and group C（n=30）. At the time of achieving the desired anesthesia plane,the patients were administered dexmedetomidine in the group D, while patients in group C were administered physiologic saline at the same amount and duration. HR, MAP, SPO2, RE and adverse events were recorded in intraoperative period were recorded. Results HR were significantly lower in group D compared to that in the group C from 15 mins after infusing to 30 mins after cessation of infusing（t=2.73,4.23,5.01,4.56, 3.92,4.25,3.12,2.89,4.24,3.78,2.92,3.29,P〈0.05）; RE were significantly lower in group D compared to that in the group C from 5 mins after infusing to 15 mins after cessation of infusing（t=3.54,3.76,4.52,6.23,5.01,4.32,4.20,2.93,3.82, 5.21,4.32,4.80,P〈0.05）; The incidence of bradycardia in group D were significantly higher than that in the group C （χ2= 4.52,P〈0.05）; The incidence of shivering in group D were significantly lower than that in the group C （χ2=4.85,P〈 0.05）. Conclusions In hydrochloric ropivacaine peridural anesthesia, intravenous administration of dexmedetomidine provides almost perfect sedation and lower incidence of shivering,but may cause bradycardia.