右美托咪定对截石位患者镇静应用的临床观察

Clinical Effect of Dexmedetomidine Sedation in Lithotomy Position

目的 研究右美托咪定用于经尿道前列电切腰硬联合麻醉截石位患者静脉镇静的可行性与安全性.方法 选择腰硬联合麻醉下行经尿道前列腺电切患者40例,ASA分级Ⅰ～Ⅱ级,患者年龄50 ～ 67岁,随机分为两组：右美托咪定组（D组）和丙泊酚组（P组）,每组各20例.截石位10min后给予D组患者右美托咪定0.5 μg/kg的负荷剂量,10min内缓慢静脉泵入,根据镇静深度给予右美托咪定的维持剂量为0.2 ～0.7μg/（kg·h）;截石位10min后给予P组患者丙泊酚1.0mg/kg负荷剂量,根据镇静深度给予丙泊酚15 ～ 20ml/h维持剂量;术中维持Ramsay镇静评分2～3分.术中监测患者生命体征、血气分析、术中舒适满意度等.结果 P组病例呼吸抑制显著多于D组（P＜0.01）.镇静后D组氧分压明显高于P组（P＜0.05）.P组患者镇静后平均动脉压下降.两组患者舒适满意度差异无统计学意义（P＞0.05）.结论 右美托咪定用于腰硬联合麻醉下经尿道前列电切患者术中镇静,无呼吸抑制,血流动力学较平稳.

Objective To study feasibility and safety of intraspinal anesthesia applied with dexmedetomidine sedation in patients un- dergoing transurethral resection of prostate （TURP） in lithotomy position. Methods Forty patients, ASA I - Ⅱ , aged 50 to 67 years, scheduled to transurethral resection of prostate（TURP） and spinal- epidural anesthesia, were equally randomized into two groups （20 in each group） ： dexmedetomidine group（ Group D） and propfol group （ Group P）. After 10 minutes of lithotomy position was placed. Pa- tients in group D received dexmedetomidine 0.5μg/kg infusion in 10 minutes and then dexmedetomidine was intravenous infused at the rate of 0.2 - 0.7μg/（ kg · h） to maintain the Ramsay score at 2 - 3 during the whole operation process. Patients in group P were received propofol 1.0mg/kg in 10 minutes followed by 15 - 20ml/h intravenous infusion to keep the same depth of sedation as patients in group D. Life Symptom,blood gas analysis and comfortable satisfaction of patients, etl were monitored and recorded contiguously during surgery. Results There was higher incident rate of respiration depression in group P （0% vs 25% , P 〈 0.01 ）. After sedation, PaO2 in patients of group D was higher than that patients of group P（P 〈0.05）. Patients in group P showed a tendency of drop in blood pressure in the process of sedation. There was no significantly difference between group D and group P in patients＇ satisfaction（ P 〉 0.05 ）. Conclusion Dexmedetomidine sedation showed no respiratory depression and stable hemodynamic in patients undergoing transurethral resection of pros- tate with intraspinal anesthesia.