右美托咪啶联合神经阻滞在老年患者下肢手术中的应用

Application of dexmedetomidine assisted nerve blocks for elderly patients undergoing lower extremity surgery

目的探讨右美托咪啶联合神经阻滞在老年患者下肢手术中的安全性和有效性。方法择期行单侧下肢手术的老年患者40例，采用随机数字表法分为腰丛联合坐骨神经阻滞组（L组）和右美托咪啶复合腰丛联合坐骨神经阻滞组（D组），各20例。分别记录麻醉前（T0）、麻醉结束（T1）、手术开始即刻（T2）、手术开始后15min（T3）、手术开始后30min（T4）和手术结束时（T5）的平均动脉压（MAP）、心率（HR）和脉搏血氧饱和度（SpO2）；术中丙泊酚和芬太尼的使用及不良反应的发生情况；以及患者术后住院天数。结果与T0时比较，L组患者MAP在T3～T5时均明显降低（均P〈0．05）；与D组比较，L组患者MAP在T3-T5时明显降低，且术中发生低血压的例数及使用丙泊酚和芬太尼的例数明显增加，术者满意度降低，差异均有统计学意义（均P〈0.05）。两组患者各时间点HR和SpO2的比较，以及术后住院天数的比较差异均无统计学意义（均P〉0．05）。结论右美托咪啶联合神经阻滞应用于老年患者下肢手术能使患者术中循环呼吸稳定、麻醉管理简便，且不良反应少、术者满意度高，值得在临床推广应用。

Objective TO investigate the efficacy and safety of dexmedetomidine assisted nerve blocks for elderly patients undergoing lower extremity surgery. Methods Forty ASA II or III elderly patients undergoing unilateral lower extremity surgery were randomly allocated to two groups （n=20 in each）： group L received lumbar plexus combined with sciatic nerve block and group D received dexmedetomidine assisted nerve blocks. The mean arterial pressure （MAP）, heart rate （HR） and pulse oxygen saturation （SpO2） were recorded at each time point as follows： pre-anesthetic（T0）, anesthetic ends （T1）, 0 （T2）, 15 （T3） and 30 （T4） rain after incision, and the end of surgery （T5）; side effects, requirement for propofol and fentanyl, doctor＇s satisfaction during operation, and postoperative hospital stay were also recorded. Results In group L, MAP at T3-T5 was significantly decreased （P〈0.05）, comparing with the baseline value at To. Compared with group D, MAP at T3 - T5 was significantly decreased in group L （P〈0.05）; while the incidences of hypotension, requirements for propofol and fentanyl were significantly increased, and doctor＇s satisfaction dropped in group L （P〈0.05）. There were no statistical difference in HR and SpO2 at each time points between two groups, as well as the postoperative hospital stay （P 〉0.05）. Conclusion Dexmedetomidine can increase the efficacy of lumbar plexus combined with sciatic nerve block when used for lower extremity surgery in the elderly patients, which shows stable hemodynamic performance, simple anesthesia management, fewer side effects and higher doctor＇s satisfaction.