不同剂量右美托咪定对腰－硬联合麻醉下高龄患者下腹部手术的影响

摘要

目的：探讨不同剂量右美托咪定对腰－硬联合麻醉下高龄患者下腹部手术的镇静效果的影响。方法：选取年龄≥65岁的腰－硬联合麻醉下行腹部手术的患者120例，随机分为右美托咪定组（D1、D2、D3组）及咪达唑仑组（M组）。分别记录患者麻醉前（T0）、用药后5 min（T1）、30 min（T2）、60 min（T3）Ramsay 评分及记录术中、术后出现不良反应的例数。结果：D1、D2、D3组及 M组在 T1～T3时 Ramsay 评分显著高于同组 T0时的评分，差异有统计学意义（P＜0.05）；在 T1～T3时，D2、D3的 Ramsay 评分均高于 M组，差异有统计学意义（P ＜0.05）；与 M组相比，D1、D2、D3组的不良反应（心动过缓、恶心呕吐）显著减少，差异有统计学意义（P ＜0.05）。结论：右美托咪定辅助高龄患者腰－硬联合麻醉下腹部手术时可产生理想镇静状态，其不良反应较少，其中以0.3～0.5μg／kg 为初始剂量，以0.3μg／（kg·h）进行维持为宜。%Objective To investigate the effect of different doses of dexmedetomidine in the elderly patients at combined spi-nal -epidural anesthesia with lower abdominal surgery.Method 120 elderly patients at combined spinal -epidural anesthesia with lower abdominal surgery were chosen into DEX group(group D1、D2、D3)and midazolam group.Ramsay sedation score were evaluated at time points of before(T0 )、5 min(T1 )、30 min(T2 )、60 min(T3 )after treatment.The side effects in these patients were also recorded.Results Compared with T0 in all group,ramsay sedation score increased significantly at T1 ~T3 ,the difference was statistically significant (P <0.05).In group D2 and D3,ramsay sedation score were increased significantly at T1 ~T3 com-pared with group M,the difference was statistically significant (P <0.05).The side effect(bradycardia、nausea and vomiting) were more happened in group M,the difference was statistically significant (P <0.05).Conclusion For the elderly patients at combined spinal -epidural anesthesia with lower abdominal surgery,appropriate dose of DEX caused effective seda-tion.Intravenous injection DEX 0.3 ~0.5 μg/kg with 5 minutes followed by maintenance infusion of 0.3 μg/kg is suggested.