老年患者腰麻联合静脉应用右美托咪定的麻醉效应与安全性

目的评估老年患者腰麻联合静脉应用右美托咪定（DMT）的麻醉效应和安全性。方法 2012年1月至2013年5月在武警后勤学院附属医院拟行经尿道前列腺电切术的老年患者（65~75岁）纳入本研究,用随机数字表法随机分为DMT组和对照组。2组患者均用5.0 mg/ml布比卡因2.0 ml腰麻,腰麻前DMT组缓慢静脉注射DMT 0.5μg/kg,并以0.5μg/（kg·h）的速度持续静脉泵入至手术结束。对照组以相同速度静脉注射及泵入等容量0.9%氯化钠注射液。比较2组患者的麻醉效应（最高感觉阻滞平面及其消退时间、镇静评分）、不良反应发生情况和在麻醉后监护病房（PACU）的停留时间。结果 86例患者纳入本研究。DMT组43例,平均年龄（69±5）岁;对照组43例,平均年龄（71±6）岁。2组患者术中收缩压、舒张压、心率、脉搏血氧饱和度及最高感觉阻滞平面的差异均无统计学意义。DMT组与对照组比较,最高感觉阻滞平面消退时间[（223±38）min比（155±26）min]、术中镇静评分[（4.2±1.9）分比（2.1±1.3）分]、低血压发生率[20.9%（9例）比2.3%（1例）]、心动过缓发生率[44.2%（19例）比4.7%（2例）]、在PACU停留时间[（245±43）min比（195±38）min]及低氧饱和度发生率[14.0%（6例）比0]的差异均有统计学意义（均P〈0.05）。过度镇静发生率[9.3%（4例）比0]差异无统计学意义（P〉0.05）。对出现血压降低、心动过缓和低氧饱和度的患者分别予以麻黄碱、阿托品及吸氧后,症状均得到改善。结论老年患者行腰麻联合静脉应用DMT可增强镇痛与镇静效果且较为安全。应警惕心动过缓、低血压、低氧饱和度等不良反应,加强监测并及时处理。

Anaesthetic effect and safety of lumbar anesthesia combined with intravenous dexmedetomidine in elderly patients

Objective To evaluate anesthetic effect and safety of lumbar anesthesia combined with intravenous dexmedetomidine（DMT） in elderly patients.Methods The elderly patients（aged 65 to 75 years） undergoing prostate electrocision through urethra from January 2012 to May 2013 in Logistics College Hospital of Chinese People＇s Armed Police Forces were enrolled into this study and were divided into DMT group and control group using a random number table.The patients in the two groups received bupivacaine（5.0 mg/ml） 2.0 ml for lumbar anesthesia.The patients in the DMT group received a slow intravenous bolus of DMT（0.5 μg/kg） before anesthesia and pumped DMT continuously at a rate of 0.5 μg/（kg ？ h） until the end of operation.The patients in the control group received the same volume of 0.9%sodium chloride solution for injection at the same rate.The anesthetic effects（maximal sensory block plane and regression time,sedation score）,adverse reactions and the residence time in post anesthesia care uint were compared between the two groups.Results A total of 86 patients were enrolled into this study.DMT group comprised 43 cases with the average age of（69±5） years and the control group comprised 43 cases with the average age of（71±6） years.There were no significant differences in the systolic pressure, diastolic pressure,heart rate,pulse oxygen saturation（SpO_2） and maximal sensory block plane of patients during the operation between the two groups.The differences of regression time of maximal sensory block plane,sedation score during operation,incidence of hypotension,incidence of bradycardia,and the residence time in post anesthesia care unit between DMT group and the control group were（223±38） min vs.（155±26） min,（4.2±1.9） vs.（2.1±1.3）,20.9%（9 cases） vs.2.3%（1 case）,44.2%（19 cases） vs.4.7%（2 cases）,and（245±43）min vs.（195±38） min,respectively.The differences were statistically significant（all P0.05）.The difference in incidence of excessive sedation between DMT group and the control group[9.3%（4 cases） vs.0]was not statistically significant,the incidence of low pulse oxygen saturation[14.0%（6 cases） vs 0]was statistically significant（P0.05）.The patients who developed hypotension,bradycardia and low pulse oxygen saturation received ephedrine,atropine and oxygen,respectively.The patients＇ above-mentioned symptoms were improved after the treatment. Conclusions Lumbar anesthesia combined with intravenously DMT may enhance the effects of analgesia and sedation,and is relatively safe for elderly patients.The clinician should pay attention to the adverse reactions such as hypotension,bradycardia and low pulse oxygen saturation.The monitoring of adverse reactions should be intensified.Once adverse[reactions develop,the symptomatic treatment should be given.