右美托咪定用于老年患者经皮椎体后凸成形术的镇痛效果

Effect of dexmedetomidine on analgesia in elderly patients undergoing percutaneous kyphoplasty surgery

目的观察右美托咪定用于局麻经皮椎体后凸成形术(PKP)中的镇痛效果和对血流动力学的影响。方法择期行PKP手术老年患者80例,年龄61～82岁,随机均分为两组。D组于手术开始前持续泵注右美托咪定负荷剂量1.0μg/kg,10min泵完,后以0.5μg·kg-1·h-1维持至手术结束。C组泵注等量生理盐水。两组均用1.0%的利多卡因局部浸润麻醉,总量为30～40ml。观察患者给药后即刻(T0)、注入局麻药时(T1)、穿刺针到达椎体时(T2)、骨水泥注入时(T3)、手术结束时(T4)的MAP、HR和疼痛VAS评分。结果与C组比较,T1～T4时D组VAS评分、MAP明显降低(P<0.05),HR明显减慢(P<0.05)。与T0时比较,T1～T4时D组MAP明显降低,HR明显减慢(P<0.05);而C组MAP明显升高,HR明显增快(P<0.05)。结论右美托咪定清醒镇痛可为PKP提供较为满意的镇痛效果,降低围术期血流动力学反应。

Objective To observe the analgesic effect of dexmedetornidine and its influence on hemodynamics in patients undergoing percutaneous kyphoplasty （PKP） surgery. Methods Eighty patients undergoing PKP surgeries aged 61-82 years were randomly divided into dexmedetomidine group （group D） and the control group （group C） for 40 cases each. Group D received loading dose of intravenous infusion of dexmedetomidine 1.0 ~g/kg for 10 min, and then maintained at 0.5μg.kg-1. h-1. Group C received equivalent volume of saline. The MAP and HR were recorded at administration of immediate （To）, injection of local anesthetics（Tx ）, a puncture needle to vertebral body （T2）, bone cement injection （T3）,the end of operation （T4）,the VAS scores were assessed at T0-T4. Results Patients in the group D had lower VAS scores than those of the group C at T1-T4. At T1-T4, MAP in group D decreased significantly, HR decreased significantly （P〈0. 05） ;MAP in group C increased obviously, HR increased obviously （P〈0. 05）. Conclusion Dexmedetomidine can provide effective analgesia for patients undergoing PKP surgery reduce the perioperative hemodynamic response during operation.