目的：探讨右美托咪定-氯胺酮复合麻醉在老年硬膜外麻醉关节镜手术中的镇静作用。方法选取2013年1月～2015年1月在我院行膝关节镜手术的患者60例作为研究对象，ASA分级I级或II级，根据随机数字表法分为观察组30例和对照组30例，两组患者均进行硬膜外麻醉。观察组给予右美托咪定-氯胺酮静脉复合麻醉，对照组给予靶控输注丙泊酚和静脉注射芬太尼复合麻醉。观察两组患者OAA/S评分、BIS、SpO2、MAP、HR、BP等指标，记录麻醉诱导时间、定向力恢复时间以及不良反应情况，术后调査手术者及患者满意度。结果观察组患者术中呼吸维持平稳，SpO2均在96%以上，呼气末CO2分压维持正常；对照组共有21例SpO2低于90%，11例出现呼吸暂停，需要放置通气道和（或）辅助通气，两组差异显著（P＜0.05）；观察组术中血流动力学较对照组更加稳定，但当BIS≤60时心率下降明显；观察组麻醉诱导时间和定向力恢复时间均长于对照组（P＜0.05）；两组患者及手术医师对麻醉效果的满意度相仿。结论右美托咪定-氯胺酮复合麻醉可安全应用于老年人硬膜外麻关节镜手术，无明显抑制呼吸作用，术中患者血流动力学指标更加稳定，值得临床推广应用。%Objective To investigate the effects of application of dexmedetomidine-ketamine epidural sedation in arthroscopic operation in elderly patients.Methods Altogether 60 cases of patients who underwent knee arthroscopy in the hospital from January 2013 to January 2015 were selected as research subjects and assessed as Grade I or II in line with ASA classiifcation standards. According to random number table method, all these patients were divided into Observation Group and Control Group with 30 cases in each group. Two groups of patients accepted epidural anesthesia. Observation Group was given dexmedetomidine ketamine intravenous anesthesia, while Control Group was given target-controlled infusion of propofol and intravenous fentanyl combined anesthesia. Indicators such as OAA/S (The Observer’ Assessment of Alertness/Sedation Scale) score, bispectral index (BIS), blood oxygen saturation (SpO2), mean arterial pressure (MAP), heart rate (HR) and blood pressure (BP) were observed, and induction time, recovery time and adverse reaction conditions were recorded. Satisfaction survey of operators and patients were conducted after the surgery.ResultsPatients in Observation Group had stable breathing during the operation with average SpO2 higher than 96%. Partial pressure of end-tidal carbon dioxide was normal. A total of 21 cases in Control Group had SpO2 less than 90%; 11 patients had respiratory pause and needed to be placed through the airway and (or) assisted with ventilation. The differences between the two groups were statistically signiifcant (P<0.05). Hemodynamics in Observation Group was more stable than that in Control Group. However, when the BIS≤60, the heart rate decreased signiifcantly. The induction time and recovery time of Observation Group were longer than those of Control Group (P<0.05). Patients and operators of the two groups had similar satisfaction rate to narcotic effects. ConclusionDexmedetomidine-ketamine epidural anesthesia is a safe method for elderly patients with epidural anesthesia in arthroscopic surgery, with stable hemodynamic indicators and without signiifcant inhibition of respiration, which is worthy of clinical application.
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