右美托咪定监测麻醉复合局部麻醉在高龄患者疝修补术中的临床应用

Clinical application of dexmedetomidine in monitored anesthesia care for inguinal hernioplasty under local anesthesia in elderly patients

目的 观察右美托咪定监测麻醉管理技术（监测麻醉，MAC）复合局部麻醉在高龄患者疝修补术中应用的安全性和有效性。方法 选择2012年9月至2014年7月入住上海市徐汇区大华医院的40例腹股沟单侧疝修补术患者，随机分为MAC组（观察组）和对照组，各20例。MAC组采用局部浸润麻醉复合MAC方法，对照组仅采用局部浸润麻醉方法。记录术中心脏不良事件，低氧事件的发生率和局部麻醉药的使用量，术后随访患者对麻醉的满意度。结果 MAC组给药10min后，各时点平均动脉压（MAP）、心率（HR）、脑电双频指数（BIS）值、镇静警觉评分（OAA/S）逐渐下降，与对照组同期比较，差异均有统计学意义（P＜0.05）。MAC组内其他时点MAP、HR、BIS值、OAA/S评分与T1时点比较，差异也均有统计学意义（P＜0.05）。两组患者局麻药的使用量比较，差异有统计学意义（P＜0.05）。术后随访患者对麻醉的满意度，MAC组高于对照组，差异有统计学意义（P＜0.05）。结论 右美托咪定MAC复合局部浸润麻醉用于高龄患者疝修补术更加安全有效，可提高患者术中满意度和舒适度。

Objective To determine the safety and effectiveness of dexmedetomidine in monitored anesthesia care （MAC） combined with local anesthesia for hernia repair in the elderly patients. Methods Forty very old patients [（85.65±4.59） years old] suffering from unilateral inguinal hernia who received surgical treatment in our hospital from September 2012 to July 2014 were prospectively recruited in this study. They were randomly divided into MAC group （observation group） and the control group, with 20 cases in each group. The patients of the former group were given MAC and local anesthesia, while those from the latter only local anesthesia. The incidences of intraoperative adverse cardiac events and hypoxic events, local anesthetic dosage, and patient’s satisfaction with anesthesia in postoperative follow-up were studied and compared between the 2 groups. Results Mean arterial pressure （MAP）, heart rate （HR）, bispectral index （BIS）, and observer’s assessment of alertness/sedation （OAA/S） score were gradually declined at all time points in 10 min after administration in the MAC group, which were statistically different with that in the control group at the same period （P〈0.05）. In the MAC group, there were significant differences in MAP, HR, BIS values and OAA/S score between other time points and T1 （P〈0.05）. Significant difference was found in the local anesthetic dosage between the 2 groups （P〈0.05）. The patients of the MAC group had higher satisfaction with anesthesia care in the postoperative following-up than that of the control group （P〈0.05）. Conclusion Dexmedetomidine in MAC combined with local anesthesia is safe and effective, and improves patient’s satisfaction and intraoperative comfort in hernia repair for the elderly patients.