右美托咪定联合丙泊酚的硬膜外麻醉及镇静效果比较

Epidural anesthesia and sedation effect of dexmedetomidine combined with propofol

目的观察分析右美托咪定联合丙泊酚的硬膜外麻醉及镇静效果。方法随机选取苏州市立医院北区2012年6月至2014年12月的98例硬膜外麻醉手术患者的临床资料进行回顾性分析。其中使用右美托咪定硬膜外麻醉患者49例为右美托咪定组,右美托咪定联合丙泊酚硬膜外麻醉患者49例为联合组。统计分析两组患者镇静起效时间和苏醒时间,并观察两组患者麻醉前(T0)、维持麻醉5 min(T1)、麻醉30 min(T2)、手术结束(T3)四个时段的Ramsay镇静评分及平均动脉压(MAP)和心率(HR)情况。统计两组患者术中和术后不良反应情况。结果联合组患者的镇静起效时间和苏醒时间均明显短于右美托咪定组患者(P<0.05)。T0时两组患者Ramsay镇静评分比较差异未见统计学意义(P>0.05),T1、T2和T3时段联合组患者的Ramsay镇静评分均明显低于右美托咪定组,与镇静满意分数接近(P<0.05)。T0时、T1时两组患者MAP比较差异未见统计学意义(P>0.05),T2和T3时联合组患者MAP均明显低于右美托咪定组(P<0.05)。T0时、T3时两组患者HR比较差异未见统计学意义(P>0.05),T1时和T2时联合组患者HR均低于右美托咪定组(P<0.05)。两组患者术中术后不良反应发生率比较差异未见统计学意义(P>0.05)。结论右美托咪定联合丙泊酚进行硬膜外麻醉时镇静效果更佳,患者不良反应少,安全性高,苏醒快,有利于手术进行。

Objective To observe and analyze the epidural anesthesia and sedation effect of dexmedetomidine combined with propofol. Methods The clinical data of 98 patients underwent epidural anesthesia in the municipal hospital of Suzhou from June 2012 to December 2014 were retrospectively analyzed. Fourty nine patients with epidural anesthesia by dexmedetomidine were dexmedetomidine group,and another 49 patients with epidural anesthesia by dexmedetomidine and propofol were combination group. Sedation onset time and wake time of the two groups were counted and analyzed. Ramsay sedation score and MAP and HR situation at before anesthesia（T0）,to maintain anesthesia 5 min（T1）,anesthesia 30 min（T2）,end of operation（T3）of the two groups were observed. The adverse reactions during and after the operation were recorded. Results Sedation onset time and wake time of the combination group were significantly shorter than those of the dexmedetomidine group（P 0. 05）,and those at T1,T2 and T3 of the combination group were lower than those of the dexmedetomidine group,which were more close to calm satisfaction scores. MAP（mean arterial pres-sure）of the two groups at T0 and T1 had no significant difference（P 〉 0. 05）. MAP of the combination group at T2 and T3 were significant lower than that of the dexmedetomidine group（P 0. 05）. HR of the combination group at T1 and T2 were lower than that of the dexmedetomidine group （P 0. 05）. Conclusion The sedative effect of epidural anesthesia by dexmedetomidine combined with propofol is better and the adverse reactions are less and it is also safe,waking up quickly and conducive to surgery.