右美托咪定辅助老年人硬膜外麻醉镇静的临床效果

Sedative effect of dexmedetomidine in epidural anesthesia of aged patients with operation on abdominal region

目的探讨右美托咪定辅助应用于老年人和青年人硬膜外麻醉后的镇静、镇痛和抗不良反应效果,为临床提供参考。方法对60例ASA评分Ⅰ～Ⅱ级拟行硬膜外麻醉的病人,其中年龄60～80岁30例(老年组),25～45岁30例(青年组),硬膜外麻醉效果满意后,通过警觉/镇静(OAA/S)评分进行镇静程度评分,调整右美托咪定的输注速率使OAA/S评分维持1～2分,手术结束后停用右美托咪定。记录患者的麻醉时间、手术时间、停药后呼唤睁眼时间及OAA/S评分达4分和5分的时间;同时观察两组患者预防腹部牵扯反应有效率及术中不良反应发生情况,并加以总结分析。结果老年组和青年组麻醉时间、手术时间、停药后呼唤睁眼时间及OAA/S评分达4分和5分的时间无明显差异(P>0.05);两组预防腹部牵拉反应有效率亦无明显差异(P>0.05)。结论右美托咪定应用于一般情况好的老年人硬膜外麻醉腹部手术有良好的镇静及预防牵拉反应作用,是一种安全有效的麻醉方式。

Objective To investigate the sedative effects and the adverse reaction of dexmedetomidine （Dex） in epi- dural anesthesia of aged patients with operation on abdominal region, and to summarize experience and improve clinical outcomes. Methods 60 patients undergoing operation on abdominal region with I - II grade in ASA evaluation in epidural anesthesia in our hospital between Jun 2010 to May 2012 were divided into aged patients group （age ranged from 60 to 80 years old）and young patients group （age ranged from 25 to 45 years old）. The anesthesia time, operation time, awake time and the time to reach 4 point of alertness/sedation OAA/S score were observed~ the effective rate of preventing ab- dominal stretch response and the number adverse events were recorded in all three group and the clinic effectiveness was made an in-depth analysis. Results There was no statistically significant difference in anesthesia time, operation time, a- wake time and the time to reach 4 and 5 point of alertness/sedation OAA/S score in two groups（P〉0.05） ; there was no statistically significant difference in the effective rate of preventing abdominal stretch response in two groups （P〉0.05）. Conclusion Dexmedetomidine （Dex） used in epidural anesthesia of operation on abdominal region for aged patients is a safe and effective anesthesia which has effects of good sedation and preventing abdominal stretch response and it is a bet- ter and safe method.