硬膜外注射右美托咪定、芬太尼用于下肢手术镇痛的效果评价

Evaluation of the effects of dexmedetomidine and fentanyl for epidural analgesia in lower limb surgeries

目的 观察和评价硬膜外注射右美托咪定、芬太尼复合罗哌卡因用于下肢手术的镇痛效果.方法 美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级患者100例,按随机数字表法分为两组（每组50例）：罗哌卡因＋右美托咪定组（RD组）和罗哌卡因＋芬太尼组（RF组）.除记录循环、呼吸指标及镇静评级外,于硬膜外给药后即刻观察T1o痛觉消失时间、最高感觉阻滞平面、完全运动阻滞时间、感觉阻滞消退两个节段的时间、首次追加镇痛药物的时间及副作用的发生情况等.结果 两组患者一般情况差异无统计学意义（P＞0.05）.RD组T10痛觉消失和完全运动阻滞时间[（7.1±1.2）min和（18.0±3.6） min]明显早于RF组[（9.2±1.8） min和（22.0±3.0） min]（P＜0.05）,RD组术后镇痛时间[（361±20） min]长于RF组[（259±32） min],且硬膜外局麻药总用量[（76±10）mg]显著少于后者[（97±l4）mg]（P＜0.01）;镇静效果评级RD组（76％）显著好于RF组（18％）（P＜0.01）.RF组恶心、呕吐的发生率（28％和14％）较RD组（16％和6％）明显升高（P＜0.05）,而RD组口干的发生率（16％）显著高于RF组（4％）（P＜0.01）.结论 硬膜外注射右美托咪定用于下肢手术镇痛,可提供较为稳定的血流动力学,感觉神经阻滞起效快,术后镇痛时间延长,药物用量少,镇静效果良好.

Objective To observe and evaluate the analgesia potentiating effects of epidurally administered fentanyl and dexmedetomidine when combined with ropivacaine.Methods One hundred ASA Ⅰ-Ⅱ patients undergoing lower limb orthopedic surgery were randomly divided into two groups （n=50）：ropivacaine＋dexmedetomidine group （RD group） and ropivacaine＋fentanyl group （RF group）.Besides cardio-respiratory parameters and sedation scores,various block characteristics were also observed including the onset of T10 analgesia time,maximum sensory analgesic time,complete motor blockade time,two segmental dermatomal regressions time,first rescue analgesic time,and the incidence of side effects et al.Results The demographic profile of patients was comparable in both the groups.Compare to RF group,the onset of T10 sensory analgesia time [（7.1 ±1.2） min vs （9.2±1.8） min] and complete motor blockade time [（18.0±3.6） min vs （22.0±3.0） min] were significantly earlier in the RD group.Postoperative analgesia time was significantly longer [（361±20） min vs （259±32） min] and the total amount of epidural local anesthetic were lower [（76±10） mg vs （97±14） mg] in the RD group.Sedation scorewas much better in the RD group（76% vs 18%） （P〈0.01）.Incidence of nausea and vomiting was higher in the RF group （28% and 14% vs 16% and 6%） （P〈0.05）,while incidence of dry mouth was higher in the RD group （16% vs 4%） （P〈0.01）.Conclusions Dexmedetomidine for epidural analgesia in lower limb surgeries can provide relative stable hemodynamics,fastersensory anesthesia,prolonged post-operative analgesia,lower consumption of epidural local anesthetics and much better sedation.