经腹子宫全切术患者不同剂量右美托咪啶硬膜外麻醉镇静效果观察

Sedative Effect of Different Doses of Dexmedetomidine in Patients Undergoing Total Abdominal Hyserectomy

目的:观察不同剂量右美托咪啶在硬膜外麻醉经腹子宫全切术中的镇静效果和安全性。方法:硬膜外麻醉经腹子宫全切术择期患者120例随机分为4组,即不同剂量右美托咪啶镇静组(D1组,D2组,D3组)和咪达唑仑镇静组(M组)。D1组、D2组、D3组在手术前10 min静脉泵注右美托咪啶0.5 μg·kg-1,随之分别以0.4,0.6,0.8μg·(kg·h)-1维持输注;M组患者在手术前10 min静脉泵注咪达唑仑0.06 mg·kg-1,随之以0.04 mg·(kg·h)-1维持输注。比较各组患者入室时(T0)、确定硬膜外麻醉阻滞效果满意时(T1)、镇静药物泵注后10 min(T2)、20 min(T3)、40 min(T4)、手术结束时(T5)的平均动脉压(MAP)、心率(HR)、呼吸频率(RR)和血氧饱和度(SpO2),以及镇静药物使用时间和手术时间。评估各时点镇静程度,及术后患者手术期间遗忘程度、药品不良反应和麻醉服务满意度。结果:T3时点后,D3组HR显著低于其余3组(P<0.05);T2时点后,4组HR均明显低于T0时(P<0.05和P<0.01)。M组T3、T4时点RR显著低于其余3组(P<0.05)。与T0时比较,T2时点后,各组患者均取得显著镇静效果(P<0.05和P<0.01);D3组T3、T4时镇静评分显著优于D1组和M组(P<0.05)。4组患者均未出现明显药品不良反应。结论:硬膜外麻醉经腹子宫全切术应用右美托咪啶维持镇静无类似输注咪达唑仑后发生呼吸抑制的风险,但剂量宜低于0.8μg·(kg·h)-1。

Objective：To compare the sedative effect and safety of different doses of dexmedetomidine in the patients undergoing total abdominal hyserectomy. Methods：A total of 120 patients undergoing total abdominal hysterectomy were randomly divided into four groups, different doses of dexmedetomidine groups（D1 group, D2 group and D3 group）and midazolam group（M group） with 30 pa-tients in each. Dexmedetomidine groups received intravenous pump infusion of dexmedetomidine （0. 5 μg·kg-1 ） 10 minutes before the operation, and then the different dexmedetomidine groups were received continuous infusion of dexmedetomine of different doses：D1 group of 0. 4μg·（kg·h） -1, D2 group with 0. 6μg·（kg·h） -1 and D3 group with 0. 8μg·（kg·h） -1;M group received in-travenous pump infusion of midazolam （0. 06 mg·kg-1） 10 minutes before the operation, and then with 0. 04 mg·（kg·h） -1 con-tinuous infusion. The mean arterial pressure（ MAP） , heart rate（ HR） , respiratory rate（ RR） , oxyhemoglobin saturation（ SpO2 ） were recorded at the following time points：the moment of entering the operating room（T0）, the block effect of epidural anesthesia was satis-fied （T1）,10 min（T2）,20 min（T3）and 40 min（T4）after the drug infusion, and the end of the operation（T5）, and the duration of the medicine use and the whole operation were recorded as well. The sedation degrees were evaluated with Ramsay scale, and the am-nesic scores, adverse drug reactions and patient satisfaction were recorded after the operation. Results：Compared with that of the other groups, HR of D3 group was obviously lower after T3 （P〈0. 05）;and after T2, HR was significantly lower than that at T0 （P〈0. 05 or P〈0. 01）. Compared with the other groups, RR of M group was obviously lower at T3 and T4 （P〈0. 05）. Compared with those at T0 , the sedative effects of all the groups were much remarkable（P〈0. 05 or P〈0. 01）;and the Ramsay score of D3 group at T3 and T4 was higher than that in D1 group or M group（P〈0. 05）. There were no obvious adverse reactions in the four groups. Conclusion：The use of dexmedetomidine in the patients undergoing total abdominal hyserectomy might not lead to the risk of respiratory depression as the use of midazolam, while the dose of dexmedetomidine should be less than 0. 8 μg·（kg·h） -1.