右美托咪定与氯胺酮对蛛网膜下腔阻滞效果的比较

Effect comparison of dexmedetomidine and ketamine on subarachnoid block

目的评价右美托咪定与氯胺酮对蛛网膜下腔阻滞效果的比较。方法择期行蛛网膜下腔阻滞麻醉的患者120例,随机分为三组:生理盐水组(NS组)患者静脉滴注生理盐水10m L,速率为5m L/h,10min内完成;右美托咪定组(DEX组)患者先静脉泵注右美托咪定负荷量0.5μg/kg,继而以0.5μg/(kg·h)的速率静脉维持;氯胺酮组(KET组)患者静脉注射氯胺酮0.2mg/kg,继而以0.5μg/(kg·h)的速率静脉维持。三组患者药物干预均于蛛网膜下腔阻滞麻醉前完成。记录麻醉达最佳效果的时间、感觉和运动恢复的时间及血流动力学指数。结果与NS组比较,KET组患者麻醉起效时间更快(P<0.05)。三组患者间麻醉达最佳效果的时间差异均无统计学意义(P>0.05)。与NS组比较,KET组和DEX组患者感觉恢复和运动功能恢复时间均明显延长(P<0.05)。结论右美托咪定和氯胺酮对蛛网膜下腔阻滞麻醉均具有类似的协同作用,而氯胺酮对患者血流动力学更加平稳。

Objective To evaluate and compare the effect of dexmedetomidine and ketamine on subarachnoid block. Methods 120 patients who were undergoing elective subarachnoid space block anesthesia were divided into three groups according to random number table,with 40 cases in each group.Patients in normal saline group （NS group） were intravenously dripped of 10mL normal saline in 10min,with the dripping speed of 5mL/h,patients in dexmedetomidine group （DEX group） were intravenously pumped of dexmedetomidine,with the load quantity of 0.5μg/kg,and then keeping the venous malntenance rate of 0.5μg/（kg·h）,patients in ketamine group （KET group） were intravenously dripped of 0.2mg/kg ketamine, and then keeping the venous malntenance rate of 0.5μg/（kg·h） Results The effect onset time of anesthesia in KET group was much quicker than which in NS group（P〈0.05）.The time of reaching the best anaesthetic effect among the three groups was no statistical significance（P〉0.05）.The time of sensory restoration and motor function recovery in KET group and in DEX group had obviously longer than which in NS group（P〈0.05）. Conclusion Dexmedetomidine and ketamine on subarachnoid space block anesthesia have similar synergistic effect,while ketamine is much stabler on patients＇ hemodynamics.