盐酸右美托咪定联合瑞芬太尼在骨科手术中的麻醉效果观察

Anesthetic effect of dexmedetomidine hydrochloride combined with remifentanil in orthopedic surgery

目的观察盐酸右美托咪定联合瑞芬太尼在骨科手术中的麻醉效果。方法将ASA分级为Ⅰ级或Ⅱ级的320例明确要采用区域阻滞麻醉的骨科手术患者随机分为试验组和对照组,每组各160例。试验组静脉注射盐酸右美托咪定联合瑞芬太尼辅助镇静,对照组静脉注射丙泊酚联合瑞芬太尼辅助镇静。记录两组给药前(T0),给药后10 min(T1)、20 min(T2)、30 min(T3)和患者苏醒后(T4)各时点的呼吸频率(RR)、平均动脉压(MAP)、心率(HR)、脉搏氧饱和度(Sp O2)和警觉/镇静观察评定(OAA/S)评分情况。结果在T0、T4时间点两组研究对象观察指标差异均无统计学意义(P>0.05);对照组患者在T1、T2和T3时间点的RR和SPO2明显低于试验组,差异有统计学意义(P<0.05)。在手术过程中对照组患者出现呼吸抑制、上呼吸道梗阻和恶心呕吐等不良反应的发生率明显高于试验组(P<0.05)。结论区域阻滞麻醉采用盐酸右美托咪定联合瑞芬太尼比使用射丙泊酚联合瑞芬太尼具有较好的辅助镇静作用,安全性高,呼吸抑制程度较轻。

Objective To observe the effects of regional anesthesia with dexmedetomidine hydrochloride combined with remifentanil in orthopedic surgery. Methods Three hundred and twenty patients of ASA grade Ⅰ orⅡ scheduled for orthopedic surgery under regional block anesthesia were randomly divided into experimental group and control group, with 160 cases in each group. The experimental group applied intravenously dexmedetomidine hydrochloride combined with remifentanil for sedation, while the control group used intravenous injection of remifentanil combined with propofol for sedation. The two groups were recorded before administration（T0）, 10 min（T1）,20 min（T2）, 30 min（T3） after administration and after patients＇ recovery（T4） at respiratory rate（RR）, mean arterial pressure（MAP）, heart rate（HR）, oxygen saturation（Sp O2） and OAA/S score. Results At T0, T4, RR, MAP, HR,Sp O2, OAA/S score showed no statistically significant difference（P〉0.05）. At T1, T2 and T3, RR and SPO2 in control group were significantly lower than those in experimental group（P〈0.05）. In the process of operation, the incidences of adverse reactions（upper airway obstruction, respiratory depression, nausea and vomiting） in control group were significantly higher than those in experiment group（P〈0.05）. Conclusion Regional anesthesia using dexmedetomidine hydrochloride combined with remifentanil has better auxiliary sedation than propofol combined with remifentanil,with higher safety and lighter degree of respiratory depression.