盐酸右美托嘧啶在膝关节表面置换手术中的临床应用

Clinical Application of Dexmedetomidine for Patients Undergoing Total Kneearthroplasty

目的 观察盐酸右美托咪啶在临床膝关节表面置换术中的临床应用.方法 40例术前ASA分级Ⅰ～Ⅱ级择期膝关节表面置换手术患者,分为右美托咪啶组（D组,n=20）和对照组（C组,n=20）,行腰硬联合麻醉,D组入室开放静脉通道后即按照0.6～0.8 μg/kg剂量给予4.μg/mL的盐酸右美托咪啶注射液静脉泵注诱导,10分钟后改为0.3 ～ 0.5μg·kg 1·h 1维持,直至术毕前15分钟停药,C组则相同的方式静脉泵注生理盐水,监测并记录观察麻醉前（T0）,止血带充气前（T1）,松止血带前1分钟（T2）,松止血带后5分钟（T3）及术后6小时（T4）各个时点的平均动脉压（MAP）、HR、SpO2、Ramsay评分、VAS评分,记录术中恶心、呕吐、寒战等不良反应.结果 与D组及T0时段相比,C组在T2MAP、HR明显升高（P＜0.05）,与C组及T0相比,D组在T1、T2、T3时段心率明显减慢（P＜0.05）,与C组及T0相比,D组在T1、T2、T3Ramsay评分明显升高（P＜0.05）,T2、T4VAS评分明显降低（P＜0.05）,与D组比较,C组术中的恶心、呕吐、烦躁、寒战等不良反应的发生率高（P＜0.05）.结论 盐酸右美托咪啶应用在膝关节表面置换手术中,具有满意的镇静效果,并能减轻止血带反应,维持术中血流动力学稳定,减少术中恶心、呕吐和寒战的发生,无呼吸抑制等明显不良反应.

Objective To evaluate the clinical application of dexmedetomidine for the patients undergoing total knee arthroplasty. Methods Forty patients were divided into two groups, dexmedetomidine group （n = 20） and control group （n = 20）. Group D received dexmedetomidine loading 0.6 - 0.8/μg/kg for 10 min, maintaining 0.3 - 0.5/zg·kg^-1·h^-1, and group C in the same way as intravenous saline injection pump. MAP, HR, SpO2, Ramsay, VAS were recorded before anesthesia（T0）, tourniquet before inflatable （T0, 1 minute before tourniquet deflated （T2）, 5 minutes after tourniqut deflated （T3）, and postoperative 6 hours （T4）, adverse reactions such as nausea, vomiting, shivering were observed. Results Compared with group D and To, group C MAP, HR increased significantly in T2 （P〈0.05） compared with group C and To, group D during Tl, T2 and T3 heart rate slowed significantly （P〈0.05）, compared with group C and To, group D in Tt, T2,T3 Ramsay score increased significantly （P 〈0.05 ）, T2, T4 VAS score significantly decreased （P 〈0.05 ）. Compared with group D, nausea, vomiting, shivering and other adverse reactions increased in group C （P 〈 0.05）. Conclusion The clinical application of dexmedetomidine for the patients undergoing total knee arthroplasty has satisfactory sedation, light influence on breath and can reduce the tourniquet reaction, maintain intraoperative hemodynamic stability, reduce adverse reactions such as nausea, vomiting and shivering.