右美托咪定在硬膜外麻醉下患者镇静中的效果观察

目的：观察右美托咪定在硬膜外麻醉下患者镇静中的效果，以探索更安全有效的临床麻醉辅助镇静方法。方法选择硬膜外麻醉下行下腹部手术的患者60例，随机均分为实验组和对照组，实验组给予静脉注射右美托咪定，对照组给予静脉注射咪达唑仑。硬膜外麻醉平面达到手术要求后进行镇静，根据镇静状态评分评估镇静深度，镇静目标值为镇静评分3～4分。监测和记录患者镇静药物使用前（T1）、镇静药物使用后25 min（T2）、术毕时（T3）以及术后10 min（T4）时的MAP和HR；观察患者术中不良反应的发生率，记录达到镇静目标的时间，评估术后24 h患者对手术过程的遗忘程度。结果对照组达到镇静目标时间明显短于实验组（P〈0.01）；实验组患者T2、T3时MAP低于对照组，HR慢于对照组（P〈0.05或P〈0.01）；对照组烦躁、呼吸抑制和对手术过程的遗忘程度达到2～3级的发生率明显高于实验组（P〈0.01）。结论硬膜外麻醉中静脉给予咪达唑仑能提供有效的镇静，但易出现烦躁、呼吸抑制、遗忘程度高，而静脉注射右美托咪定辅助镇静更安全舒适，可有效避免患者出现紧张和焦虑情绪，利于手术顺利进行。

Effect observation on sedation of dexmedetomidine in patients with epidu-ral anesthesia

Objective To explore the safer effect of dexmedetomidine in patients with epidural anesthesia,in order to explore a safe and effective clinical anesthesia auxiliary composed method. Methods 60 patients suffered lower abdominal surgery with epidural anesthesia were randomly and randomly divided into experimental group and control group, the experimental group received intravenous dexmedetomidine,the control group received intravenous midazolam.Epidu-al anesthesia plane for calm after meet the operation requirements,according to the sedation scores assessed the depth of sedation,calm the target for sedation score 3 to 4 points.The mean arterial pressures and heart rates of the patients at before calm drug use （T1）,25 min after the calm drug use （T2）,at the end of operation （T3） and 10 min after the end of operation （T4）,respectively were monitored and recorded.The incidence of adverse reactions in intraoperative were observed,the achieve calm time was recorded,the procedure of forgetfulness in patients at 24 h after surgery. Results The time of achieving sedation target （T） in the control group was significantly shorter than that of the experimental group （P〈0.01）.The mean arterial pressures and heart rates in the experimental group at T2 and T3 were significantly lower than those of the control group （P〈0.05 or P〈0.01）.The incidences of tirritability,respiratory depression and the amnesia about the surgical procedures achieving 2 to 3 grade in the control group were higher than those of the experimental group （P〈0.01）. Conclusion Though intravenous midazolam can provide effective sedation,the side effects of irritability, respiratory depression,high degree of amnesia impact patients recovery from anesthesia.Intravenous dexmedetomidine assistting sedation in the epidural anesthesia is safer and more effective,which can effectively avoid stress and anxiety of patients,making the operation smoothly.