右美托咪定用于老年患者低位硬膜外麻醉22例

目的 观察右美托咪定用于老年患者低位硬膜外麻醉镇静的适合剂量和安全性. 方法选择拟行经尿道前列腺电切术的老年患者48例,随机分为右美托咪定组和对照组各24例. 两组患者均接受1.5%利多卡因连续硬膜外麻醉. 右美托咪定组患者于手术开始前10 min缓慢泵注负荷剂量右美托咪定0.5 μg. kg^-1,并以起始剂量0.2 μg.kg^-1.h^-1泵注维持,泵注速度每次增减0.1 μg.kg^-1.h^-1以维持跳动 镇静(RASS)评分为-2分. 对照组患者不给予静脉镇静用药. 观察并记录镇静评分、生命体征变化及术后并发症. 结果 右美托咪定组22例患者完成研究观察. 右美托咪定组患者都能达到良好的镇静状态;给予右美托咪定镇静后,各观察时间点心率明显降低(P<0.05);同时有更好的舒适度评价和低术后寒战发生率. 推荐右美托咪定用于老年患者低位硬膜外麻醉镇静的维持剂量为0.2～0.3 μg.kg^-1.h^-1. 结论 静脉泵注0.5 μg.kg^-1右美托咪定负荷剂量后,继以0.2～0.3 μg.kg^-1.h^-1维持,可安全有效地用于老年患者低位硬膜外麻醉的镇静.

Dexmedetomidine for Sedation During Low Epidural Anesthesia in 22 Elderly Patients

Objective To assess the security and optimal dosage of using dexmedetomidine for sedation during low epidural anesthesia in the elderly patients.Methods A total of 48 elderly patients undergoing transurethral resection prostate were randomly divided into two groups: dexmedetomidine group and control one,24 patients in each group.All patients received low epidural anesthesia with 1.5% lidocaine.Infusion of dexmedetomidine started 10 minutes before operation at a loading dose of 0.5 μg·kg-1 in the test group,with a reduction of 0.1 μg·kg-1·h-1 once to a maintenance dose of 0.2 μg·kg-1·h-1 for keeping the Richmond Agitation-Sedation Scale(RASS) to at level-2.Patients in the control received no sedative treatment.The sedation assessment,vital signs and post-operation complication were observed.Results Twenty-two patients in the dexmedetomidine group completed evaluation,and they were in a stable sedation state.Moreover,lower heart rate,more satisfaction and less shivering were observed(P<0.05).The optimal dose of dexmedetomidine for sedation during low epidural anesthesia in elderly patients was proposed at 0.2-0.3 μg·kg-1·h-1.Conclusion Loading 0.5 μg·kg-1 dexmedetomidine followed by maintaining infusion at 0.2-0.3 μg·kg-1·h-1 could provide a good and stable sedative effect during low epidural anesthesia in elderly patients.