腰椎术后患者ICU右美托咪定用量的临床研究

Clinical study on the dosage of dexmedetomidine used for patients after lumbar operation in ICU

目的探讨右美托咪定用于腰椎减压内固定术后患者不良反应与剂量的关系。方法择期全麻腰椎减压内固定手术患者120例,ASAⅠ~Ⅱ级,年龄18~65岁,术毕转入重症监护室（ICU）,完全清醒、拔除气管导管后,采用随机数字表法,将患者随机分为A、B、C 3组（n=40）：静脉注射右美托咪定（注射时间10 min）A组0.5μg/kg、B组0.75μg/kg、C组1.0μg/kg。以注射右美托咪定前1 min患者的平均动脉压（MAP）、心率（HR）为基础值,记录注射右美托咪定30 min内3组患者高血压、低血压、心动过缓、躁动、恶心呕吐、过度镇静、低氧血症等不良反应的发生情况及自控给药（PCA）次数。结果 3组患者使用右美托咪定期间均无躁动、恶心呕吐发生;3组高血压发生率、PCA次数差异无统计学意义（P〉0.05）;B、C组低血压、心动过缓的发生率高于A组（P〈0.05）;B、C组过度镇静和低氧血症发生率均为15%,与A组比较差异有统计学意义（P〈0.05）;B、C两组各指标比较差异无统计学意义（P〉0.05）。结论腰椎内固定患者术后ICU使用PCIA镇痛期间,复合0.5μg/kg右美托咪定能减少躁动、恶心呕吐及心血管不良反应发生,降低过度镇静和低氧血症的风险。

Objective To investigate the relationship between the adverse reactions and dosage of dexmedetomidine used for patients after lumbar operation in ICU. Methods 120 patients with ASA Ⅰ~Ⅱ undergone general anesthesia lumbar decompression and internal fixation operation were selected and randomly divided into three groups： group A treated with intravenous injection of dexmedetomidine with 0. 5 μg / kg in 10 min,group B with 0. 75 μg / kg,group C with 1. 0 μg / kg. The mean artery pressure（ MAP）,heart rate（ HR） 1 min before intravenous injection of dexmedetomidine was selected as the basic value. Hypertension,hypotension,bradycardia,heartbeat restlessness,nausea and vomiting,excessive sedation,hypoxemia and the incidence of adverse reactions,PCA in 30 min after intravenous injection of dexmedetomidine in three groups were recorded. Results No restlessness,nausea and vomiting occurred in three groups. The incidences of hypertension,numbers of PCA had no significant difference between the three groups. The incidences of hypotension,bradycardia in group B and group C were higher than group A（ P〈0. 05）; the incidences of excessive calm and hypoxemia in group B and group C were both 15%,with statistical difference compared with group A（ P〈0. 05）; all indexes had no statistical difference between group B and group C（ P〉0. 05）.Conclusion PCIA combined with 0. 5 μg / kg of dexmedetomidine for postoperative analgesia of lumbar internal fixation during ICU can reduce nausea,vomiting,restlessness and cardiovascular adverse reactions,also can reduce the risk of excessive sedation and hypoxemia.