监测麻醉下骨科短小手术右美托咪定镇静效果观察

Observation of dexmedetomidine efficacy when used for simple orthopedic limb surgery with monitored anesthesia care

目的:观察监测麻醉(MAC)下盐酸右美托咪定用于骨科短小手术的镇静效果。方法选择2013年7月—2014年1月于MAC下行骨科短小手术的患者60例,随机分为观察组、对照组各30例。观察组患者给予右美托咪定负荷量0.3μg/kg静脉输注(持续时间15min),维持量0.3μg/kg.h-1,对照组持续输注等容积生理盐水至手术结束前10min。记录各组不同时间点:输注盐酸右美托咪定前(T0)、输注盐酸右美托咪定15分钟后(T1)、行局部麻醉即刻(T2)、手术开始后30min(T3)、术毕(T4)患者的MAP、HR、RR、SpO2、OAA/S评分,评价、记录患者术中呼吸抑制情况及术中合作程度,术毕记录各组患者局麻药用量,以上数据进行比较。结果组内比较,观察组T1、T2、T3、T4时刻HR、OAA/S评分均低于T0时刻,有统计学意义(P<0.05);对照组与T0时刻相比,T1、T2、T3、T4时刻,MAP、HR、RR、SpO2、OAA/S评分无显著性差异。与对照组比较T1、T2、T3、T4时刻,观察组HR、OAA/S评分及患者局麻药用量、呼吸抑制发生率、患者手术配合程度有统计学差异(P<0.05)。结论监测麻醉下行骨科短小手术,持续泵注右美托咪定0.3μg/kg. h-1镇静效应明显,血流动力学平稳,无呼吸抑制作用,增加患者手术配合依从性,MAC中合理应用盐酸右美托咪定是安全、有效的。

Objective To observe the efficacy of dexmedetomidine in simple orthopedic limb surgery with monitored anesthesia care(MAC).Methods 60 patients undergoing simple orthopedic limb surgery with MAC between 2013.07 and 2014.01 were selected and randomly divided into an observation group and a control group,with 30 cases in each group.Patients in observation group given 0.3μg/Kg dexmedetomidine via intravenous infusion(duration 15 min),the maintenance dose is 0.3μg/Kgoh.Patients in control group given continuous normal saline infusion until 10 minutes before surgery ended.The patients'MAP,HR,RR,SpO2,OAA/S score,dosage of local anesthetics,respiratory depression and intraoperative coordination were recorded before administration of dexmedetomidine(T0),15 minutes after administration and time of sterilization(T1),administration of local anesthetic(T2)and start of surgery 30 min(T3),and at completion of surgery(T4).Results The observation group patients'MAP,SpO2 at T1,T2,T3 and T4 is not statistically significant(P>0.05)compared to T0,but HR was lower compared to T0,the control group patients'MAP,HR at T2,T3 were higher compared to T0,and SpO2 was lower than at T0,the difference is statistically significant(P<0.05).The observation group at time points from T1 to T4 had decreased OAA/S scores,and statistically significant compared to the control group(P<0.05).The difference between the observation group's and control group's local anesthetic dosage,incidence of respiratory depression and degree of patients'cooperation were also statistically significant(P<0.05).Conclusion Monitor status of patients under anesthesia during simple orthopedic limb surgery,0.3μg/Kg dexmedetomidine loading dose and 0.3μg/Kg.h maintenance dose in patients resulted in discernable sedative effects,patients also showed stable hemodynamics,less stress reaction,no respiratory depression,were more easily woken up and oriented.increase patient compliance with surgery.This shows dexmedetomidine is safe to use as sedative in simple orthopedic limb surgery with MAC.