目的:观察国产右美托咪定(艾贝宁)对腹部手术患者硬膜外麻醉辅助作用的临床效果及不良反应,评价其可行性.方法:选择60例ASA Ⅰ-Ⅱ级腹部手术患者.随机分为:A、B、C 3组,每组20例.A组硬膜外麻醉成功后静脉微泵泵注右美托咪定1 μg/kg,10 min泵完,继以0.5 μg/(kg·h)维持.B组硬膜外麻醉成功后静脉微泵泵注右美托咪定0.5 μg/kg,10 min泵完,继以0.5 μg/(kg·h)维持.C组硬膜外麻醉成功后单次静脉微泵泵注哌替啶1 mg/kg,10 min泵完.观察3组患者用辅助药前(T0)、用药后10 min(T1)、15 min(T2)、20 min(T3)、30 min(T4)患者的心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)、患者警觉/镇静观察评定(OAA/S)评分.记录3组预防腹部牵扯反应有效率及术中不良事件的例数.结果:(1)A、B与C组比较:A、B两组T2、T3、T4时OAA/S评分明显低于C组(P＜0.05).A组HR、MAP泵药后明显降低,与C组比较差异有统计学意义(P＜0.05).B组泵药后HR与C组比较下降明显(P＜0.05),两组MAP无明显差异.3组SpO2无明显差异.(2)A与B组比较:A组T1、T4时HR和T4时OAA/S评分下降明显,与B组比较差异有统计学意义(P＜0.05).(3)3组用药后HR从T1开始明显下降,与T0比较均有显著差异(P＜0.05);MAP、SpO2及OAA/S评分从T2开始明显下降,与T0比较均有显著差异(P＜0.05).(4)预防腹部牵拉反应有效率A、B组明显高于C组(P＜0.01).结论:国产右美托咪定应用于硬膜外麻醉腹部手术,有良好的镇静及预防牵拉反应作用,是一种安全有效的麻醉方式,以0.5 μg/kg为负荷量继以0.5μg/(kg·h)维持为最佳.%Objective To observe the adjunctive effect and the adverse reaction of domestic dexmedetomidine (Dex) used in epidural anesthesia of operation on abdominal region, and to assess the feasibility. Methods Sixty patients undergoing operation on abdominal region, ASA Ⅰ-Ⅱ, were randomly divided into three groups; Dex A group (group A, n = 20), Dex B group (group B, n = 20), and control group (group C, n = 20). In group Dex A, after epidural anesthesia, Dex was intravenous pumped with loading dose 1 (μg/kg in ten minutes, and then pumped with maintenance dose 0.5 (μg/kg. In group Dex B, after epidural anesthesia, Dex was intravenous pumped with loading dose 0.5 μg/kg in ten minutes, and then pumped with maintenance dose 0.5 μg/ kg. In control group, after epidural anesthesia, pethidine was intravenous pumped with single dose 1 mg/kg in ten minutes. Heart rate (HR), mean arterial pressure (MAP), pulse blood oxygen saturation (SpO2), and alertness/ sedation (OAA/S) score were observed in all three groups in five points: pre using adjunctive drugs (To), ten minutes post using adjunctive drugs (T1), fifteen minutes post using adjunctive drugs (T2), twenty minutes post using adjunctive drugs (T3), and thirty minutes post using adjunctive drugs (T4). The effective rate of preventing abdominal stretch response and the number adverse events were recorded in all three groups. Results (1) The comparison of group A, B and C: the OAA/S score in T2, T3, T4 in group A and group B were lower than that in group C (P < 0.05). HR and MAP in group A descended obviously post pumping drugs, and the difference was significant compared with group C (P < 0.05). HR in group B descended obviously post pumping drugs compared with group C (P < 0.05), there was no significant difference of MAP in group B and group C. And there was no significant difference of SpO2 in these three groups. (2) The comparison of group A and B: HR in T1 and T4, OAA/S score in T4 in group A descended significantly compared with group B (P < 0.05). (3) The comparison of T0 with other points: in all three groups, HR descended from T1; MAP and SpO2 and OAA/S score descended from T2, and the difference was significant (P < 0.05). (4) The effective rate of preventing abdominal stretch response in group A and B was higher significantly than that in group C (P < 0.01). Conclusion Domestic dexmedetomidine (Dex) used in epidural anesthesia of operation on abdominal region is a safe and effective anesthesia, which has effects of good sedation and preventing abdominal stretch response, and the best dose selection is loading dose 0.5 μg/kg with maintenance dose 0.5 μg/kg.
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