右美托咪定在高血压病患者蛛网膜下隙阻滞的应用研究

Study of dexmedetomidine in hypertension patients undergoing subarachnoid block

目的探讨盐酸右美托咪定(DEX)对高血压病患者蛛网膜下隙阻滞行全髋置换术的镇静效果及对循环及呼吸功能影响。方法将34～82岁、ASAⅡ～Ⅲ级接受全髋置换术的高血压患者40例,随机分为咪唑安定组(M组)和右旋美托咪啶组(D组);M组,术前10min给予负荷剂量30μg/kg后以0.05mg/(kg.h)速率持续泵注咪唑安定;DEX组,术前10min给予负荷剂量1μg/kg,然后以0.5μg/(kg.h)速率持续泵注DEX;给药10min后进行;观察并记录入室时、给药后10 min、麻醉后5min、30min及90min患者的血压、心率及脉搏血氧饱和度(SpO2)和Ramsay镇静评分。结果两组患者在入室时SBP、DBP、HR差异无统计学意义(P>0.05)。给药10min后、麻醉后5min、30min、90min两组患者SBP、DBP、HR均较入室时下降(P<0.05),两组间SBP、DBP比较差异无统计学意义(P>0.05),D组患者HR较M组下降更为明显(P<0.05)。组内比较,麻醉后5min患者SBP、DBP、HR均较其余各时点降低(P<0.05)。与M组比较,D组呼吸抑制的发生率降低,心动过缓发生率升高(P<0.05)。结论右美托咪定可对高血压病患者蛛网膜下隙阻滞下行全髋置换术时产生良好的镇静、抗焦虑作用和轻微的中枢降压作用,增强循环稳定,不产生呼吸抑制作用,可安全应用于高血压患者腰麻下的镇静。

Objective To investigate the effect of dexmedetomidine（DEX） on sedation and on the cardiovascular and respiratory system responseses in hypertension patients undergoing total hip replacement with subarachnoid block.Methods Forty hypertension patients（ASAII-III） aged 34～82 years old undergoing total hip replacement were randomized equally into two groups,midazolam group（M group） and dexmedetomidine group（D group）.The patients in the midazolam group were administrated 10min preoperatively with 30/kg midazolam then received continuous infusion of midazolam at the rate of 0.05mg/（kg·h）,the patients in the dexmedetomidine group were administrated 10min preoperatively with 1μg/kg dexmedetomidine then received continuous infusion of dexmedetomidine at the rate of 0.5μg/（kg·h）.Ramsay sedation scale,Blood pressure,Heart rate（HR） and SpO2 were recorded prior to anesthesia,10min after administration,5min,30min and 90min after anaesthesia.Results There was no significant difference in SBP、DBP、HR at prior to anesthesia both of groups（P0.05）.SBP、DBP、HR at 10min after administration,5min,30min and 90min after anaesthesia significantly decreased than that at prior to anesthesia both of groups（P0.05） but comparison between the two groups SBP、DBP had no significant difference（P0.05）.HR of D group at 10min after administration,5min,30min and 90min after anaesthesia significantly decreased than M group（P0.05）.The incidence rate of respiratory inhibition was lower in the dexmedetomidine groups compared with the M group（P0.05）,but the incidence rate of bradycardia was higher in D group compared with the M group（P0.05）.Conclusion Circulation is stabilize in hypertension patients undergoing total hip replacement with subarachnoid block by dexmedetomidine administrated with sedation and center depressurization and no respiratory inhibition,which is safe for sedation in hypertension patients undergoing total hip replacement with subarachnoid block.