摘要
目的观察不同剂量右美托咪定在老年患者局麻疝修补术中的镇静效果。方法选择ASA I～II级,年龄> 65岁,无高血压、糖尿病、冠心病病史,肝肾功能正常,心率>60次/min的局麻疝修补术患者。随机分为右美托咪定0.2μg/(kg·h)(D1组)、0.4μg/(kg·h)(D2组)、0.6μg/(kg·h)(D3组);手术开始前给予0.5μg/kg右美托咪定10 min静脉泵完,舒芬太尼0.2μg/kg,之后分别予右美托咪定0.2μg/(kg·h)、0.4μg/(kg·h)、0.6μg/(kg·h)持续泵至手术结束。如术中VAS镇痛评分≥3分,追加舒芬太尼0.1μg/kg。观察并记录每组患者入室后T0、切皮时T1、手术开始后30 min T2、60 min T3、手术结束时T4,每个时间点的心率、平均动脉压、镇静程度(Ramsay评分)、不良反应以及舒芬太尼使用例数。结果与T0比较,3组在T4时刻HR都显著下降,D2和D3组在T2、T3时刻心率都显著下降(P<0.05)。与D1比较,D2和D3组在T2、T3时刻心率都显著下降(P<0.05)。与D1比较D3组在T2、T3、T4时刻MAP都显著下降(P<0.05),与T0比较,D3组在T2、T3、T4时刻MAP都显著下降(P<0.05)。与T0时刻和D1组比较,D2和D3组在T2、T3、T4时刻Ramsay都显著下降(P<0.05)。与D1组比较,D2、D3组低血压,心动过缓的发生率明显增加,D3组低氧的发生率显著增加(P<0.05)。与D3组比较,D1组舒芬太尼的使用及高血压发生率明显增加(P<0.05)。结论老年患者局麻疝修补术中手术开始前10 min给予0.5μg/kg右美托咪定,术中以0.4μg/(kg·h)维持,镇静效果明显,血流动力学平稳,不良反应发生较少,值得在临床运用及推广。
Objective To observe the sedation effect of different doses of dexmedetomidine （DEX ） insenile patients undergone herniorrhaphy under local anesthesia.Methods Patients undergone herniorrhaphyunder local anesthesia and at ASA Level I-II,aged over 65,without history of hypertension,diabetes or coronaryheart disease,with normal hepatorenal function,and with heart rate of over 60 beats per minute were selected.Those patients were randomly divided into 0.2 μg/（kg·oh）DEX group （group D1）,0.4 μg/（kg· oh） DEX group（group D2 ） and 0.6 μg/（kg·oh） DEX group （groupD3 ） . Before operation,all the patients were given venoustransfusion with 0.5 ug/kg DEX within 10 minutes and given 0.2 ug/kg sufentanil. Afterwards,patients in the threegroups were given venous transfusion with respectively 0.2μg/（kg.oh）, 0.4μg/kg oh and 0.6μg/（kg.oh） DEX until the operation ended. If the intraoperative VAS score was no less than 3 points, 0.1 ug/kg sufentanil would be given to the patients additionally. The heart rate, mean arterial pressure, sedation level （Ramsay score） and adverse reactions of all the patients and the number of cases administrated with sufentanil at To （after entry to the operating room）, T1 （when skin incision）, T2 （30min after the operation started）, T3 （60min after the operation started） and T4 （when the operation ended） were observed and recorded. Results Compared with To, the heart rate in all three groups decreased significantly at 14, and the heart rate in group D2 and D3 decreased significantly at T2 and T3 （P 〈 0.05） . Compared with group D1, the heart rate in group D2 and D3 decreased significantly at T2 and T3 （P 〈 0.05） . Compared with group D1, MAP in group D3 decreased significantly at T2, T3 and T4 （P 〈 0.05） Compared with To, MAP in group D3 decreased significantly at T2, T3 and T4. Compared with To and D1 group, Ramsay in group D2 and D3 decreased significantly at T2, T3 and T4 （P 〈 0.05） . Compared with group D1, the
作者
王兴耀
陈建春
屈启才
欧阳杰
马军
周臣
WANG Xing-yao;CHEN Jian-chun;QU Qi-cai;OU Yang-jie;MA Jun;ZHOU Chen(Dept.of Anesthesiology,Xuanwei Hospital of Traditional Chinese Medicine,Xuanwei 655400;Dept.of Anesthesiology The 2nd Affiliated Hospital of Kunming Medical University,Kunming 650101,China)
出处
《昆明医科大学学报》
CAS
2018年第11期35-38,共4页
Journal of Kunming Medical University
基金
国家自然科学基金资助项目(81060033)
云南省卫生系统学科带头人基金资助项目(D-201213)
关键词
右美托咪定
局麻
疝修补
镇静效果
Dexmedetomidine
Local anesthesia
Hemiorrhaphy
Sedative effect
