右美托咪定在腰丛联合坐骨神经阻滞麻醉中的应用

The Application of Dexmedetomidine to Elderly Patients Undergoing Anesthesia of the Lumbar Plexus Block Combined with Sciatic Nerve Block

目的：观察右美托咪定用于辅助腰丛联合坐骨神经阻滞麻醉患者的镇静效应及安全性。方法择期下肢手术患者60例，随机分为D组，M组（ n＝30）。神经阻滞后，M组予以芬太尼1．5μg／kg＋咪唑安定0．05 mg／kg；D组给予右美托咪定0．5μg／kg，10 min静脉注射后，予以0．5μg／（ kg· h）维持。监测并记录观察麻醉前（ T0）、给药后10（T1）、30（T2）、60min（T3）时的平均动脉压（MAP）、心率（HR）、脉氧饱和度（SpO2）及脑电双频指数（BIS）值，并观察不良反应。结果与T0比较，D组、M组T1～T3时MAP、HR降低，BIS值均下降（P＜0．05），两组各时间点BIS值、MAP与HR差异无显著性。 M组T1～T2时SpO2下降（ P＜0．05），D组SpO2无显著变化，D组与M组SpO2在T1～T2时点的比较差异有显著性（P＜0．05） 。结论右美托咪定用于老年患者腰丛联合坐骨神经阻滞麻醉中镇静，效果确切，血流动力学稳定，不良反应少。

Objective To observe the sedative effects and safety of dexmedetomidine applied to patients undegoing anesthesia of the lumbar plexus block combined with.Methods 60 patients undergoing lower limb surgery were randomly divided into Group D and group M （ n=30） .After nerve block,Group M received fentanyl 1.5μg/kg＋midazolam 0.05 mg/kg;Group D received dexmedetomidine 0.5μg/kg intravenously for 10min and then maintained with 0.5μg/（ kg· h） . Then Monitored and recorded were MAP,HR,SpO2 ,BIS value before anesthesia,10,30,60 mins respectively after dexmedetomidine administrated.Results When compared with group D, the MAP,HR lower,BIS values of group M were decreased at T1~T3 （ P〈0.05） and there were no differences in BIS values,MAP and HR at each time point;SpO2 of Group M decreased at T1~T2 （ P〈0.05） and SpO2 of Group D had no significant changes;There were significant difference for SpO2 in group M and group D at T1~T2（P〈0.05）.Conclusion The application of dexmedetomidine for elderly patients undergoing combined lumbar plexus and sciatic nerve block anesthesia have effective sedation with stable hemodynamics and fewer adverse reactions.