右美托咪啶用于椎管内麻醉镇静的临床观察

摘要

Objective:To observe efficacy and safety of sedation with dexmedetomidine in intraspinal anesthesia. Methods: Ninty patients ( ASAI - II ) were randomly divided into 3 groups (n = 30). Dexmedetomidine' s loading dose was 0. 4μg/kg, 5 min later maintenance dose was added, group I was 0. 3μg/kg · h, group II was 0. 5 μg/kg · h, group III was 0. 7μg/kg · h. MAP, HR, RR, SpO2 were recorded at baseline (T0), 1 min (T1), 5 min (T2),10 min (T3), 30 min (T4) and when surgery was complete ( T5) . The Ramsay score and postoperative forgetting effect was evaluated. Results: RR, SpO2 were within the normal range in 3 groups at each time points( P > 0.05 ). MAP, HR were decreased, but no significant difference between the groups ( P > 0.05 ). Group I and II was not statistically different at T0. Group III ' s MAP decreased significantly and HR was significantly slower at T2 and T3 ( P < 0. 05 ). Group III and group III ' s Ramsay score and forgetting degree was better than that of group I at each time points(P <0. 05). Conclusion: In intraspinal anesthesia, sedation with dexmedetomidine 0.5μg / kg · h is safe and effective.%目的:观察右美托咪啶用于椎管内麻醉镇静的效果和安全性.方法:选择ASA Ⅰ～Ⅱ级行择期手术椎管内麻醉患者90例,随机分为3组,每组30例.右美托咪啶负荷剂量0.4 μg/kg(5 min)后,Ⅰ组维持量0.3 μg/( kg.h),Ⅱ组0.5μg/(kg·h),Ⅲ组0.7 μg/(kg·h)持续泵注至术毕.分别记录基础值(T0),右美托咪啶负荷剂量后1(T1)、5(T2)、10(T3)、30 min(T4)和术毕(T5)各时间点MAP、HR、RR、SpO2,并对患者进行Ramsay评分和术后遗忘效果评价.结果:3组各时间点RR、SpO2均在正常范围内(P＞0.05)；3组给药后各时间点MAP、HR均有下降,组间差异无统计学意义(P＞0.05),与T0时比较,Ⅰ、Ⅱ组差异无统计学意义,T2、和T3时,Ⅲ组MAP明显下降、HR明显减慢(P＜0.05)；Ⅱ、Ⅲ组各时间点Ramsay评分和遗忘程度明显优于Ⅰ组(P＜0.05).结论:在椎管内麻醉中,采用右美托咪啶0.5 μg/(kg.h)术中镇静是安全、有效的.