右美托咪定预防腰硬联合麻醉下经尿道前列腺电切术中寒战的临床观察

Clinical observation of Dexmedectomidine in prevention of shivering in transurethral prostatectomy under combined spinal and epidural anesthesia

目的观察右美托咪定预防腰硬联合麻醉下经尿道前列腺电切术中寒战的效果。方法选择在腰硬联合麻醉下行经尿道前列腺电切术患者60例，ASA1～3级。随机分为生理盐水组（A组），右美托咪定组（B组），每组30例。丽组均采用腰硬联合麻醉。B组给予右美托咪定（浓度为4txg／m1）3μg/（kg·h）持续10min，然后以右美托咪定（浓度为4＋g／m1）0．3μg/（kg·h）维持至手术结束；A组给予同等剂量的生理盐水。分别记录电切持续时间、电切45min时警觉与镇静评分、电切45min时寒战分级、患者术毕满意度评分情况。结果两组患者电切持续时间差异均无显著性（P〉0．05），电切45min时警觉与镇静评分、电切45min时寒战分级、患者术毕满意度评分均差异有显著性（P〈0．05），B组比A组，镇静效果明显、寒战发生率更低、术毕满意度更佳。结论右美托咪定能够有效预防腰硬联合麻醉下经尿道前列腺电切术中寒战，并且提高患者的手术满意度。

Objective To observe the effect of dexmedetomidine in prevention of shivering in transurethral prostatect,~my under the combined spinal and epidural anesthesia. Methods Totally 60 cases in combined spinal - epidural anesthesia to transurethral prostatectomy, ASA 1 -3, were randomly divided into saline group （group A ） and dexmedetomidine group （group B） ,30 cases in each group. Dexmedetomidine was administrated（4 p.g/ml） in a dose of 3 ~g,/（ kg ~ h）for 10 min, and then maintained in a dose of 0. 3 wg/（ kg ~ h） until the end of the surgery in group B ;The same dose of saline was ad- ministrated in group A. The duration of prostatectomy, assessment of the alertness/sedation scale at the forty - fifth minutes of prostatectomy, shivering grading at the forty -fifth minutes of prostatectomy ,and satisfaction score of patient at the end of the surgery were recorded. Results The duration of prostatectomy had no significant difference between the two groups （P 〉 0. 05 ）. However, the difference of assessment of the alertness/sedation scale at the forty- fifth minute of prostatectomy, shivering grading at the forty - fifth minute of prostateetomy and satisfaction score of patient at the end of the surgery were significant （ P 〈 0. 05 ） , furthermore, group B had better sedative effect,lower incidence of shivering, higer satisfaction score than group A. Conclusion Dexmedetomidine can effectively prevent shivering in transurethral prostatectomy under the combined spinal and epidural anesthesia to and improve patient＇ s satisfaction.