微量右美托咪啶蛛网膜下腔用药对罗哌卡因腰麻效果的影响

The Influence of Intrathecal Low-dose Dexmedetomidine on Ropivacaine Spinal Block

目的:观察蛛网膜下腔注射国产右美托嘧啶对罗哌卡因腰麻效果的影响。方法:选择会阴部手术、经尿道前列腺或膀胱电切术等择期手术病人120例,随机分为两组(n=60例)。经L3、4脊间隙穿刺至蛛网膜下腔,注射含(研究组)或不含(对照组)右美托嘧啶(3μg)的局麻药液2mL(含罗哌卡因12mg)。观测感觉和运动神经阻滞和恢复时间、血流动力学变化以及镇静水平。结果:两组感觉阻滞平面达T10时间和最高阻滞平面(中位数)无明显区别;研究组运动神经阻滞完成时间(运动阻滞达Bromage3级时间)明显短于对照组(P=0.00<0.05);研究组感觉和运动恢复时间明显长于对照组(P均=0.00<0.001),两组术中和术后平均动脉压、心率和镇静水平相近,术后随访两周未发现有背部和下肢感觉运动异常情况。结论:蛛网膜下腔注射微量国产右美托咪啶(3μg)能明显延长罗哌卡因阻滞作用时间,但无明显血流动力学干扰及镇静效应。术后两周的后续随访均未发现有背部和下肢感觉和运动功能异常等并发症。

Objective：To observe the effects of intrathecal low-dose dexmedetomidine on the ropiva-caine spinal block .Method：120 patients undergoing transurethral resection of prostate or bladder tumor and other perineum surgery under spinal block were randomly allocated into two groups （ n =60 ） .Hyperbaric ropivacaine solution （12mg） with （control group） or without （research group） dexmedetomidine （3μg） was injected into subarachnoid cavity .The onset time to reach peak sensory and motor levels , and the sensory and motor regression time were recorded .Hemodynamic changes and the level of sedation were also measured . Result：There＆#39;s a significant shorter onset time of motor block （P＆lt;0.05）, and significantly longer sensory and motor regression time patients in research group （ P＆lt;0.05） than those in control group .The NBP , HR and level of sedation during and after operation were similar in two groups .Conclusion： Dexmedetomidine （ 3μg） , when added to ropivacaine intrathecally , produces a longer time block on both sensory and motor nerves with preserved hemodynamic stability and lack of sedation .