摘要
目的比较右美托咪定和咪达唑仑用于蛛网膜下腔阻滞麻醉(简称腰麻)复合镇静时对血流动力学的影响。方法选取2016年6月至2018年6月陕西省肿瘤医院收治的116例采用腰麻行膝关节镜手术的患者作为研究对象,采用随机数字表法分为咪达唑仑组和右美托咪定组,每组各58例。咪达唑仑组采用10 mg咪达唑仑稀释至50 mL(0.2 mg/mL)按1.0 mL/(kg·h)负荷剂量静脉泵注10 min;右美托咪定组采用200μg右美托咪定稀释至50 mL(4μg/mL)按1.0 mL/(kg·h)负荷剂量静脉泵注10 min。麻醉开始前(T0)、腰麻后5 min(T5)、腰麻后10 min(T10,即开始给予咪达唑仑或右美托咪定时)及腰麻后40 min内每5 min(T15~T40)记录收缩压、舒张压、平均动脉压、心率、脉搏血氧饱和度和双频脑电指数(BIS)。术后收集麻醉后恢复室(PACU)停留时间和Ramsay镇静评分。结果咪达唑仑组患者手术过程中心动过缓发生率和阿托品使用率均明显低于右美托咪定组,而低血压发生率高于右美托咪定组,差异均有统计学意义(P<0.05);T10、T15~T40时,咪达唑仑组和右美托咪定组患者收缩压、平均动脉压、心率和BIS比较,差异均有统计学意义(P<0.05);与咪达唑仑组比较,右美托咪定组患者在进入PACU时的Ramsay镇静评分更高,而在PACU停留的时间更长,差异均有统计学意义(P<0.05)。结论与咪达唑仑比较,右美托咪定用于腰麻复合镇静时可减少术中低血压发生率,但易引起心动过缓,延长在PACU停留的时间和镇静恢复时间。
Objective To compare the hemodynamic effects of dexmedetomidine and midazolam during combined spinal anesthesia sedation.Methods A total of 116 patients undergoing spinal anesthesia for knee arthroscopic surgery in Shaanxi Cancer Hospital from June 2016 to June 2018 were randomly assigned to midazolam group[n=58,10 mg midazolam diluted to 50 mL(0.2 mg/mL)at 1.0 mL/(kg·h)loading dose intravenously pumped for 10 min]and dexmedetomidine group[n=58,200μg dexmedetomidine diluted to 50 mL(4μg/mL)was pumped intravenously at a loading dose of 1.0 mL/(kg·h)for 10 min].Systolic blood pressure,diastolic blood pressure,mean arterial pressure,heart rate,pulse oxygen saturation,and bifrequency EEG index(BIS)were recorded before anesthesia(T0),5 min after lumbar anesthesia(T5),10 min after lumbar anesthesia(T10,when midazolam or dexmedetomidine was started),and every 5 min for 40 min after anesthesia(T15-T40).The length of stay in the post anesthesia recovery room(PACU)and Ramsay sedation score were collected after surgery.Results The incidence of bradycardia and atropine use in midazolam group was significantly lower than that in dexmedetomidine group(P<0.05),and the incidence of intraoperative hypotension was higher than that in dexmedetomidine group(P<0.05).The change rate of systolic blood pressure,mean arterial pressure,heart rate and BIS value were significantly different between the two groups during T10,T15,and T40(P<0.05).Compared with the midazolam group,patients in the dexmedetomidine group had a lower Ramsay sedation score in the PACU and a longer stay in the PACU(P<0.05).Conclusion Compared with midazolam,dexmedetomidine can reduce the incidence of intraoperative hypotension,but it is easy to cause bradycardia,and prolong the stay time in the recovery room and the recovery time of spinal anesthesia.
作者
陈玲
赵华
赵培西
朱涛
王琳
CHEN Ling;ZHAO Hua;ZHAO Peixi;ZHU Tao;WANG Lin(Department of Pharmacy,Shaanxi Cancer Hospital,Xi′an,Shaanxi 710061,China;Department of Pharmacy,Shaanxi Friendship Hospital,Xi′an,Shaanxi 710061,China;Clinical Pharmaceutics Room,Shaanxi Cancer Hospital,Xi′an,Shaanxi 710061,China)
出处
《检验医学与临床》
CAS
2023年第8期1033-1037,共5页
Laboratory Medicine and Clinic
基金
陕西省重点研发计划项目(2018SF-036)。
