右美托咪定与丙泊酚用于硬膜外麻醉的镇静效果比较

目的 探索比较在硬膜外麻醉下,右美托咪定和丙泊酚二者的镇静效果、血流动力学改变以及相关不良反应发生的情况.方法 60例行单侧大隐静脉高位结扎剥脱术的患者,随机分为丙泊酚组(P组,n=30)和右美托咪定组(D组,n=30).术中记录两组患者入室后(T0)、静脉输注镇静药物前(T1)、切皮时(T2)、手术开始后30 min(T3)、手术开始后60 min(T4)、手术开始后90 min(T5)、手术结束时(T6)、患者离室前(T7)共8个时间点的MAP、HR、SpO2、BIS、警觉/镇静评分(OAA/S),以及术中心动过缓、低血压、呼吸抑制等不良反应的发生情况以及术中因镇痛不足使用舒芬太尼的情况.结果 在T2~T6各时间点,与D组比较,P组MAP下降更为显著,差异有统计学意义(P<0.05);P组患者的HR比D组快,差异有统计学意义(P<0.05).T2~T6各时间点,P组患者的BIS值比D组大,差异有统计学意义(P<0.05),D组患者的OAA/S评分比P组少,差异有统计学意义(P<0.05).在不良反应的比较中,D组患者低血压和呼吸抑制的发生率低于P组,差异统计学意义(P<0.05),D组患者低血压和呼吸抑制的发生率显著低于P组.其余不良反应的发生率无统计学差异(P>0.05).结论 右美托咪定和丙泊酚均能为硬膜外麻醉提供满意的镇静效果,二者相比,右美托咪定在血流动力学的稳定性上更具优势,不良反应更少,安全性更高.

Comparison of the effect of dexmedetomidine and propofol in epidural anesthesia

Objective To investigatethe effects of dexmedetomidine and propofolin epidural anesthesia,such as sedative effects, hemodynamics and related adverse reactions.Methods Sixty patients,who underwent single Saphenous vein stripping surgery,were enrolled into the study.Patients were randomly divided into two groups: propofol group (group P, n=30) and dexmedetomidine group (group D, n=30).MAP, HR, SpO2, BIS, alertness / sedation score (OAA/S), intraoperative adverse reactions and the status of simultaneous sufentanilusage due to inadequate analgesia were recorded.Results At T2~T6time points, the MAP in group P decreased significantly compared to group D (P<0.05).HR in group D decreasedsignificantly than group P at T2~T6(P<0.05).BIS values ingroup D were lower than group P at T2~T6(P<0.05);OAA/S scores in group D were higher than group P at T2~T6(P<0.05).The incidence of hypotension and respiratory depression in group D was significantly lower than that in group P (P<0.05).There were no significant differences in the incidence of other adverse reactions (P>0.05).Conclusion Dexmedetomidine and propofolcan provide satisfactory sedationinepidural anesthesia.In comparison, dexmedetomidine has a greater advantage in hemodynamic stability, fewer adverse reactions,and higher security.