腰丛联合坐骨神经阻滞下足踝手术患者右美托咪定和丙泊酚靶控输注镇静效果的比较

The comparison of dexmedetomidine with propofol TCI for combined lumbar plexus-sciatic nerve blockade during foot and ankle surgery

目的比较右美托咪定和丙泊酚靶控输注用于足踝手术的镇静效果及安全性。方法选择我院2012年6～12月在腰丛联合坐骨神经阻滞下足踝手术患者46例。随机分为右美托咪定组(D组)和丙泊酚组(P组),麻醉前给予芬太尼1μg/kg,行腰丛坐骨神经阻滞后,D组给予右美托咪定0.7μg/(kg·10min)负荷量后,以0.4μg/(kg·h)的速率静脉输注,P组靶控输注1μg/ml丙泊酚。记录给药前(T0),切皮前即刻(T1),手术开始后15min(T2)、30min(T3)、45min(T4),及术毕(T5)、术后1h(T6)时OAA/S评分,BIS值,血流动力学参数(MAP和HR),呼吸参数(RR和SpO2)。记录术中及术后恶心呕吐、口干、注射痛发生率。术后用测试卷记录患者对镇静满意度。结果两组切皮到手术开始45minOAA/S评分明显低于各自基础值(P<0.05),D组OAA/S评分在手术开始45min明显低于P组(P<0.05)。P组的呼吸频率及SpO2在镇静期明显低于D组(P<0.05)。其他临床数据差异均无统计学意义(P>0.05)。结论右美托咪定应用于腰丛联合坐骨神经阻滞下足踝手术的镇静和镇痛是安全可行的,没有明显的循环和呼吸抑制,是合理的辅助用药。

Objective To compared the analgesic effect between dexmedetomidine and propofol during foot and ankle surgery. Methods Forty-six patients were randomly allocated into two groups to receive either dexmedetomidine or propofol for elective foot and ankle surgery. Fentanyl 1 μg/kg i.v. was given before anesthesia. Dexmedetomidine was in-fused at 0.7 μg/（kg· 10 min） followed by an infusion rate of 0.4 μg/（kg·h）. Propofol was used by target controlled infusion （TCI）, 1 μg/ml was set as start target plasma concentration. The Observer＇s Assessment of Alertness/Sedation scores （OAA/S）, BIS, hemodynamics and respiratory variables were recorded regularly from administration initiation to 1 h after the operation was completed. The rate of nausea and vomiting, dry mouth, injection pain severity were recorded during op-eration. Results The OAA/S with dexmedetomidine was significantly lower than that with propofol at 45 min （P 〈 0.05）. During sedation, the respiratory rate and SpO2 in the propofol group was significantly slower than that in the dexmedetomi-dine group （P 〈 0.05）. There was no significant difference in other clinical variables between the two groups （P 〉 0.05）. Conclusion Dexmedetomidine can be used safely and effectively for sedation and analgesia during foot and ankle surgery.