右美托咪定复合罗哌卡因硬膜外麻醉在老年患者骨科手术的应用

Application of dexmedetomidine combined with ropivacaine in epidural anesthesia for orthopedic surgery in elderly patients

目的观察右美托咪定（dexmedetomidine，Dex）复合罗哌卡因硬膜外麻醉用于老年患者骨科手术的临床效果。方法选择2012年6月。2013年12月在我院手术治疗的美国麻醉医师协会（ASA）分级Ⅰ级～Ⅱ级的老年骨科下肢手术患者60例，采用随机数字表法分为两组（每组30例）：对照组（R组）硬膜外注射0．75％罗哌卡因15ml＋生理盐水1ml；Dex组（D组）硬膜外注射0．75％罗哌卡因15ml＋Dex0．5ug／kg（1m1）。比较两组患者感觉阻滞的起效时间、感觉阻滞持续时间、感觉平面阻滞上限、达到最高平面时间、运动阻滞起效时间和运动阻滞持续时间，并比较两组患者镇静评分、副作用发生情况和术后认知功能障碍（postoperative cognitive dysfunction，POCD）的发生情况。结果与R组比较，D组患者感觉阻滞的起效时间[（6．3±1．1）min比（7．7±1．5）min，P〈0．01]、运动阻滞的起效时间[（14．1±1．2）min比（16．2±1．5）min，P〈0．01]缩短，感觉阻滞的持续时间[（337±60）min比（295±52）min，P〈0．01]和运动阻滞的持续时间[（155±31）min比（128±26）min，P〈0．01]延长；两组患者术中镇静评分比较，差异无统计学意义（P〉0．05）；两组患者围术期副作用发生情况差异无统计学意义（P〉0．05）；在术后1、3d，D组患者POCD发生率低于R组患者[6．8％比26．7％，0比16．7％，（P〈0．05）]。结论Dex复合罗哌卡因硬膜外麻醉用于老年患者骨科下肢手术效果优于单纯应用罗哌卡因，并能够减少术后POCD的发生率。

Objective To Observe the clinical effect of dexmedetomidine （Dex） combined with ropivacaine in epidural anesthesia for orthopedic surgery in elderly patients. Methods Sixty elderly patients with ASA Ⅰ - Ⅱ grade under lower limb orthopedic surgery in our hospital from june 2012 to december 2013 were slected and divided into two groups with random number method（n=30）. Patients in control group （group R） received epidural injection 0.75% ropivacaine 15 ml and saline 1 ml. Patients in Dex group （group D） received epidural injection 0.75% ropivacaine 15 ml and dex 0.5 ug/kg （1 ml）. The onset time of sensory block and motor block, sensory block ceiling plane, the highest plane of time, duration of sensory block and motor block were comparised, and the Ramsay score,the incidence of adverse events and postoperative conditions of postoperative cognitive dysfunction （POCD） in the two groups of patients were compared. Results Compared with group R, the onset time of sensory block[（6.3±1.1 ）min vs （7.7＋1.5） min, P〈0.01 ] and motor block [（14.1±1.2） min vs （16.2±1.5） min, P〈0.01 ] were shortened, the duration of sensory block [ （337±60） min vs （295±52） min, P〈0.01 ] and motor block [ （ 155 ±31 ） rain vs （128±26） min, P〈 0.01 ] were prolonged in group D. There were no significant difference in Ramsay score and perioperative adverse reactions between two groups （P〉0.05）. On first day and third day after surgery, the incidence of POCD in group D was lower than that in group R （6.8% vs 26.7%, 0 vs 16.7%, P〈0.05 ）. Conclusions The efficacy of Dex combined with ropivacaine in epidural anesthesia for orthopedic surgery in elderly patients exceed the simple application of ropivacaine, and reduced the incidence of postoperative POCD.