右美托咪定在椎间孔镜手术中应用的临床研究

A retrospective study on dexmedetomidine used in transforaminal endoscopic operation

目的探讨右美托咪定在椎间孔镜手术的镇静、镇痛效果及最佳给药剂量。方法回顾性分析85例行椎间孔镜手术患者的临床资料,按照右美托咪定的不同剂量分为5组[A组:未输注右美托咪定;B组:右美托咪定0.2μg/(kg·h);C组:右美托咪定0.3μg/(kg·h);D组:右美托咪定0.4μg/(kg·h);E组:右美托咪定0.5μg/(kg·h)]。比较给药后血压、心率、脉搏血氧饱和度及清醒镇静评分(OAA/S)和疼痛语言描述评分(VRS),辅助阿片类药物剂量,术中并发症发生率。结果除A组手术开始时血压值明显高于入室时(P<0.05),不同右美托咪定剂量组的术中血压均有一定的下降;手术结束时所有患者的血压、心率都比入室时的血压、心率明显降低。A组的疼痛发生率为83.3%(10/12)、B组为86.2%(25/29)、C组为66.7%(12/18)、D组57.1%(8/14)、E组50.0%(6/12),A、B组患者疼痛率高于C、D、E组。5组患者术中无呼吸抑制发生。结论右美托咪定0.5μg/(kg·h)具有良好的镇静、镇痛及降压作用,对呼吸影响小,麻醉并发症少,适用于腰椎间盘突出症患者椎间孔镜手术的麻醉。

Objective To study the sedative and analgesic effects of different doses of dexmedetomidine on the pa- tients with lumbar disc herniation who undergoing transforaminal endoscopy, and to explore the optimal dose of dexme- detomidine for transforaminal endoscopy. Methods The clinical data of 85 cases undergoing transforaminal endoscopy were retrospectively analyzed. The patients were divided into 5 groups, no dexmedetomidine was used in group A, 0.2, 0.3,0.4,0.5 μg/（kg- h） dexmedetomidine was used in group B, C, D, E retrospectively. The blood pressure（BP）, heart rate, SpO2, OAA/S and VRS, opioid dose and the incidence of intraoperative complications were observed. Results BP in group A elevated when the operation began, which was compared to the preoperative pressure. BP decreased in group B, C, D, E. The positive pain rate was 83.3%（10/12） in group A, 86.2%（25/29）in group B, 66.7%（ 12/18）in group C, 57.1% （8/14） in group D, 50.0% （6/12）in group E. The positive pain rate in group A and B was higher than in group C, D and E. No respiratory depression occurred in all groups. Conclusion Dexmedetomidine 0.5 μg/（kg, h） offers a good sedation, analgesia and antihypertension effection, which also has few influence on respiration and few anesthesia complications. It＇s suitable for the anesthesia of patients with lumbar disc herniation undergoing transforaminal endoscopy.