右美托咪定用于俯卧位硬膜外麻醉患者镇静的临床观察

摘要

Objective To observe the feasibility and safety of epidural anesthesia applied with Dexmedetomidine seda-tion in patients undergoing percutaneous nephrolithotomy operation in prone position. Methods 40 patients in Beijing Aerospace General Hospital from April to August 2012, ASA Ⅰ-II, scheduled to percutaneous nephrolithotomy and epidural anesthesia, were randomly divided into two groups:Dexmedetomidine group (group D) and control group (group C), with 20 cases in each group. After 10 minutes of prone position was placed, in patients of group D, Dexmedetomidine was slowly infused at dose of 0.5 μg/kg in 10 minutes (loading dose), then maintain a starting dose of 0.2 μg/(kg·h) infusion. Every 10 minutes for a richmond agitation-sedation scale (RASS) score, according to the score, Dexmedetomi-dine dose corresponding changes of 0.1μg/(kg·h) to maintain the RASS score at-2. Patients in group C were not given any intravenous sedation agent. RASS scores at different timing, respiratory rate and general vital signs of the two groups were recorded. Arterial blood was draw at epidural plane after fixation (T1), prone position after 10 minutes (T2) and intravenous medication reaches a predetermined depth of sedation after 10 minutes (T3) for blood gas analysis. The surgery comfortable satisfaction of patients was assessed after operation for 24 hours. Postoperative complications within 24 hours were recorded. Results During the operation, RASS score in group D was significantly lower than group C (P< 0.01); the respiratory frequency in group D was significantly increased than patients in group C at the same time point (P< 0.01); there was no significant difference be-tween the two groups in SpO2, PaO2, PaCO2 (P> 0.05);after T3, the blood pressure and heart rate in the patients of group D were gradually decreased, MAP and HR in group D were lower than those in group C (P<0.01);satisfaction of patients in group D was significantly higher than those in group C (P< 0.05); postoperative complications in group D was lower than that in group C (P< 0.01). Conclusion Dexmedetomidine sedation shows stable hemodynamic, no respiratory depression, less adverse reaction and can be safe-ly used for prone position in patients with epidural anesthesia undergoing percutaneous nephrolithotomy.%目的：观察右美托咪定静脉镇静用于俯卧位经皮肾镜取石术硬膜外麻醉患者的可行性与安全性。方法选取2012年4~8月在北京航天总医院40例行硬膜外麻醉下经皮肾镜取石术患者，ASA分级I~Ⅱ级，随机分为两组：右美托咪定组(D组)和对照组(C组)，每组20例。俯卧位后10 min D组缓慢泵注右美托咪定0.5μg/kg的负荷剂量，并以起始剂量0.2μg/(kg·h)泵注维持。每10分钟进行1次RASS评分，根据评分，右美托咪定的剂量每次相应增减0.1μg/(kg·h)以维持RASS评分为-2分。 C组患者不给予静脉镇静用药。术中记录两组患者各时间点的RASS评分、呼吸频率和一般生命体征。麻醉平面确定后10 min(T1)、俯卧位后10 min(T2)、镇静开始10 min(T3)时采集动脉血行血气分析，患者术中舒适满意度于术后24 h评定。记录术后24 h内并发症。结果手术期间各时点患者RASS评分D组显著低于C组(P<0.01)；D组患者呼吸频率较同时点C组显著增加(P<0.01)；两组患者各时点血氧饱和度、动脉氧分压、动脉血二氧化碳分压比较差异均无统计学意义(P>0.05)；镇静开始后，D组患者血压逐渐下降，心率减慢，D组平均动脉压、心率均低于C组(P<0.01)；D组患者术中满意度显著高于C组(P<0.05)，术后并发症显著低于C组(P<0.01)。结论右美托咪定可安全用于俯卧位经皮肾镜取石术硬膜外麻醉患者的静脉镇静，血流动力学较平稳，无呼吸抑制，不良反应少。