右美托咪定辅助腰丛-坐骨神经联合阻滞在老龄患者下肢手术中的应用

Application of Dexmedetomidine Assisting Lumbar Plexus-ischiadic Nerve Blocks on Aged Patients with Lower Extremity Surgery

目的 探讨右美托咪定辅助腰丛-坐骨神经联合阻滞在老龄患者下肢手术中的麻醉效果.方法 将2013年6～12月武汉市第一医院麻醉科收治的44例行单侧下肢手术的老龄患者依据随机数字表法分为两组：对照组（22例）采用腰丛-坐骨神经联合阻滞,观察组（22例）采用腰丛-坐骨神经联合阻滞后,再静脉泵注右美托咪定.分别观察两组患者围术期间血流动力学变化、Ramsay法镇静评分、输液量和神经阻滞麻醉效果.结果 手术开始切皮时,与对照组比较,观察组血压显著升高、心率显著降低（均P＜0.01）.手术开始后30、45 min与入手术室时比较,对照组血压、心率均显著上升（均P＜0.01）.与对照组比较,观察组各时间点Ramsay法镇静评分显著升高（均P＜0.01）,神经阻滞麻醉效果优于对照组（P＜0.01）.结论 右美托咪定辅助腰丛-坐骨神经联合阻滞用于老龄患者下肢手术安全可靠、效果确切,术后麻醉并发症少,是一种较为理想的麻醉方法.

Objective To study the anesthetic effect of dexmedetomidine assisting lumbar plexus-ischiadic nerve blocks on aged patients with lower extremity surgery.Methods A total of 44 aged patients with lower extremity surgery were collected in Wuhan First Hospital from Jun.2013 to Dec.2013.They were randomly divided into two groups according to random-number table method.Patients in the control group （22 cases） were applied lumbar plexus-ischiadic nerve nerve blocks Patients in the observation group（22 cases） were applied dexmedetomidine by venous pump after lumbar plexus-ischiadic nerve blocks.The changes of hemodynamic,Remasay sedation scores,fluid intake and output and anesthetic effect of both groups were respectively recorded during the period of operation.Results Compared with patients in the control group,blood pressure of patients in the observation group increased significantly and heart rate reduced significantly at the time point of cutting the skin （P 〈 0.01）.At the 30th min and 45th min after operation,both blood pressure and heart rate of patients in the control group increased significantly compared to that of the beginning（P 〈 0.01）.Compared with the control group,Ramasay sedation score of the observation group increased significantly at each time point and the anesthetic effect was better（P 〈 0.01）.Conclusion Dexmedetomidine assisting lumbar plexus-isehiadic nerve blocks applied on aged patients with lower extremity surgery has good safety and reliable effect,and less postoperative anesthetic complications,thus is an ideal anesthetic method.