酒石酸布托啡诺复合右美托咪定用于老年患者局麻下椎体成型术的临床观察

目的：探讨酒石酸布托啡诺复合右美托咪定用于老年患者局麻下椎体成型术的安全性和有效性。方法：选择择期拟行经皮椎体成型术（percutaneous vertebroplasty，PVP）治疗的患者60 例，随机分为右美托咪定+ 酒石酸布托啡诺组（DB 组）及右美托咪定+ 生理盐水组（DS 组），每组各30 例。所有患者在局麻前予以右美托咪定静脉泵注（负荷剂量：0.5 μg·kg-1，维持剂量：0.5 μg·kg-1·h-1）。局麻时给予DB 组患者酒石酸布托啡诺15 μg·kg-1 静脉注射，DS 组患者则予以等量生理盐水。分别记录所有患者入室后5 min（T0）、改俯卧位时（T1）、套管针插入时（T2）、骨水泥注入时（T3）及术毕即刻（T4）的平均动脉压（mean artery pressure，MAP）、心率（heart rate，HR）、VAS 及Ramsay 评分；记录术中呼吸抑制、心动过缓等不良事件。结果：与DS 组比较，T1~T4 时DB 组患者MAP 明显更低，而T1~T3 时DB 组患者HR 也更低（P<0.05）；T2~T3 时，DB 组患者Ramsay 评分显著低于DS 组（P<0.05），而DB 组患者VAS 评分在T1~T2 时明显低于DS 组（P<0.05）；两组间呼吸抑制、心动过缓等不良反应发生率比较无统计学差异（P>0.05）。结论：酒石酸布托啡诺复合右美托咪定有利于维持患者术中血流动力学稳定，降低患者术中疼痛评分，且不增加不良事件发生率。

Clinical Observation of Butorphanol CombinedDexmedetomidine with in Vertebroplasty under LocalAnesthesia in Elderly Patients

Objective：To investigate the safety and efficacy of butorphanol combined with dexmedetomidine in vertebroplasty under local anesthesia in elderly patients. Methods：Sixty patients scheduled to undergo elective percutaneous vertebroplasty （PVP） were enrolled and randomly assigned into two groups，dexmedetomidine + butorphanol group（ DB group，n=30）and dexmedetomidine + normal saline group （DS group，n=30）. All patients received intravenous infusion of dexmedetomidine before operation （loading dose：0.5 μg·kg-1，maintenance dose：0.5 μg·kg-1·h-1）. Simultaneously，patients in DB group were given intravenous injection of butorphanol 15 μg·kg-1，while patients in DS group were given intravenous injection of the same volume of normal saline. The mean arterial pressure （MAP），heart rate （HR），VAS and Ramsayscores were recorded 5 min after entering the operation room （T0），at the time of changing of positon （T1），trocar insertion （T2），cement injection （T3） and the end of operation （T4）. The intraoperative adverse events were also recorded，such as respiratory depression and bradycardia. Results：Compared with DS group，the MAPs were lower at T1~T4 and HRs were lower at T1~T3（P<0.05）；the Ramsay score between DS group and DB group at T0~T4 were similar （P>0.05）； however，the VAS scores in DB group were lower at T1~T2 than that in DS group （P<0.05）. There was no statistical difference existed when comparing the adverse events，such as respiratory depression and bradycardia，among two groups （P>0.05）. Conclusion：Dexmedetomidine combined with butorphanol could be safely used in vertebroplasty under local anesthesia. It could help to maintain the hemodynamic stability，reduce pain intensity and did not increase the incidence of adverse events during surgery.