不同剂量右美托咪定辅助低位硬膜外麻醉在骨科下肢手术的临床效果

摘要

Objective To explore the clinical effect of application of different dosages of dexmedetomidine assisted epidural anesthesia in orthopedic surgery of lower limbs. Methods A total of 108 patients with lower limb orthopedic surgery were performed epidural anesthesia with dexmedetomidine assistance. These 108 patients were divided into A,B,C and D groups with 27 cases in each group. Pateitns in group A were used dexmedetomidine infusion at 0. 4 μg/ kg and patients in group B with dexmedetomidine infusion at 0. 6 μg/ kg. Patients in group C were pumped with dexmedetomidine 0. 8 μg/ kg and patients in group D were served as control group,and they were pumped with saline. At the begin-ning,10 min,30 min,60 min and 120 min of dexmedetomidine infusion,MAP,HR and Ramsay sedation scores,intraoperative and postoperative adverse reactions were recorded and compared among these groups. Results When dexmedetomidine was given at the start in each group,MAP and HR had no significant difference. After the dexmedetomidine was pumping for 10 min,30 min,60 min and 120 min,HR and MAP in group A,B and C were significantly lower than those of group D,but there was no significant difference among group A,B and C. Ramsay sedation scores in patients of group C after pumping of dexmedetomidine at 10 min,30 min,60 min and 120 min were significantly higher than those of pa-tients in group A,B and D. Ramsay sedation scores in pateitns of group B after the dexmedetomidine was pumping at 10 min ,30 min,60 min and 120 min were significantly higher than those in patients of group A and D. 4 patients in group C needed to be given with atropine for increasing heart rate,with the ratio significantly higher than that of other groups. Three patients in group C were found to require vasopressor dopamine, hence the ratio was significantly higher than that of other groups. Conclusion The infusion of dexmedetomidine at 0. 6 μg/ kg assisted epidural anesthesia can achieve the best clinical sedative effect,with less adverse reactions,hence it is worthy to be administrated for clinical application.%目的 探讨不同剂量右美托咪定辅助低位硬膜外麻醉在骨科下肢手术的临床效果.方法 选择108例骨科行下肢手术的患者,进行低位硬膜外麻醉,并予以右美托咪定辅助.108例患者被分为A、B、C、D四个组,每组27例.A组泵注右美托咪定0.4μg/kg、B组泵注右美托咪定0.6μg/kg、C组泵入右美托咪定0.8μg/kg,D组为空白对照组,泵入生理盐水.于泵入右美托咪定开始时、10 min、30 min、60 min、120 min记录并比较MAP、HR、Ramsay镇静评分,观察术中、术后不良反应.结果 在泵入右美托咪定开始时,各组MAP、HR不存在统计学差异,在泵入右美托咪定后10 min、30 min、60 min和120 min,A组、B组、C组MAP水平显著低于D组,但A组、B组和C组三组之间无统计学差异.C组Ramsay镇静评分在在泵入右美托咪定后10 min、30 min、60 min和120 min显著高于A组、B组、D组,B组Ramsay镇静评分在在泵入右美托咪定后10 min、30 min、60 min和120 min显著高于A组和D组.C组有4例患者需要给予阿托品提高心率,其比率显著高于其他各组.C组中发现3例患者需要多巴胺升血压,其比率显著高于其他各组.结论 在骨科下肢手术中,泵注右美托咪定0.6μg/kg辅助低位硬膜外麻醉能达到最好的临床镇静效果,不良反应少,值得临床应用.