右旋美托咪定用于下肢骨折手术临床疗效观察

Observation on clinical effect of dexmedetomidine during the limb surgery

目的观察右旋美托咪定(DEX)持续泵注对下肢骨折手术患者血流动力学和寒颤反应的影响。方法择期下肢骨折手术患者60例,随机分为两组,右旋美托咪定组(D组,n=32)和对照组(C组,n=28)。所有患者均采用L3～4间隙硬膜外-蛛网膜下腔联合麻醉(CSEA),麻醉平面固定后开始持续泵注DEX0.4～0.6μg·kg-1·h-1,C组泵注等体积生理盐水,记录两组患者从入室到术毕6个时点(T0～T5)的MAP、HR、SpO2及术中寒颤情况。结果 MAP组间比较无差异(P>0.05);组内与T0比较有差异(P<0.05)。D组HR显著低于C组(P<0.05);组内与T0比较有差异(P<0.05)。SpO2组间比较无差异(P>0.05),组内与T0比较有差异(P<0.05)。D组寒颤发生率低于C组(P>0.05)。结论 DEX持续泵注用于下肢骨折手术可提供良好的镇静效应及血流动力学稳定,减少术中寒颤发生。

Objective To observe the effect of dexmedetomidine（DEX） with continuous infusing on hemodynamics and rigors in the limb surgery.Methods Sixty patients with the limb surgery were randomly divided into two groups：DEX group（Group D,n=32） or control group（Group C,n=28）.After the combination of epidural-spinal anesthesia（CSEA） on the L3~4,in Group D,0.4-0.6μg·kg-1·h-1 intravenous dexmedetomidine was maintained until 10 minute before operation end,in Group C,equal volume normal saline was given.The MAP,HR,SpO2 and were monitored on T0-T5.Results No difference in MAPS between groups（P〉0.05）.Groups showed a difference when compared to T0（P〈0.05）.HR in group D were lower than Group C（P〈0.05）.There were significant differences within groups when compared to T0（P〈0.05）.No significant differences in SpO2 between groups（P〉0.05）.There were significant differences within groups when compared to T0（P〈0.05）.Each point SpO2 was greater than or equal to 97% in the two groups.The rigors in Group D was lower than in Group C,however no differences（P〈0.05）.Conclusion DEX continuous infusing in the limb surgery can lead favourable sedation,hemodynamic stability and decrease rigors.