地佐辛联合右美托咪定对老年患者腰丛-坐骨神经阻滞麻醉效果的影响

The effects of dezocine and dexmedetomidine on lumbar plexus and sciatic nerve block anesthesia in elderly patients

目的：观察地佐辛联合右美托咪啶对老年患者腰丛-坐骨神经阻滞的有效性和安全性。方法：择期行单膝置换手术的老年患者90例,ASA分级Ⅱ~Ⅲ级,年龄68~80岁,随机分为3组（n=30）：Ⅰ组静脉缓慢注射右美托咪啶负荷量0.5μg/kg,继之以0.2μg/（kg·h）维持;Ⅱ组静脉注射地佐辛0.1 mg/kgⅢ组静脉注射地佐辛0.1 mg/kg和右美托咪啶负荷量0.5μg/kg,继之右美托咪定以0.2μg/（kg·h）维持;Ⅰ、Ⅲ组手术结束前10 min停药,三组用药15 min后开始腰丛-坐骨神经阻滞。观察记录入室（T0）、腰丛穿刺前（T1）、上止血带时（T2）、手术开始后5 min（T3）、手术开始后30 min（T4）、手术结束（T5）时患者平均动脉压（MAP）、心率（HR）、血氧饱合度（Sp O2）、术中呼吸频率（RR）和Ramsay镇静评分,不良反应发生率及术后VAS。结果：3组T2时间点MAP、HR均高于其它时间点,Ⅱ、Ⅲ组T2时间点MAP低于Ⅰ组,差异有统计学意义（P〈0.05）;Ⅰ组T1时间点HR明显减慢,差异有统计学意义（P〈0.05）;Ⅱ组Ramsay镇静评分在T1~T5时间点低于Ⅰ、Ⅲ组,差异有统计学意义（P〈0.05）;术后VASⅡ、Ⅲ组明显低于Ⅰ组,差异有统计学意义（P〈0.05）。Ⅰ组发生低血压2例、Ⅲ组发生低血压3例,经适当补液或给予麻黄碱5 mg即纠正;Ⅱ、Ⅲ组均有3例术中出现恶心但未吐,自行缓解。三组均未发生呼吸抑制、低血氧。结论：地佐辛联合右美托咪定可增强老年患者腰丛-坐骨神经阻滞的镇痛、镇静效果,无明显的呼吸抑制,安全性好。

Objective To investigate the effects and safety of dezocine and dexmedetomidine on lumbar plexus and sciatic nerve block anesthesia in elderly patients.Method Ninety ASAⅡorⅢ patients,aged 68 to 80 years,scheduled for elective tibial fracture surgeries were randomly divided into three groups （n =30）：groupⅠ（dexmedetomidine）、groupⅡ（dezocine）and group Ⅲ （dezo-cine and dexmedetomidine）.GroupⅠwere administered with Dexmedetomidine 0.5 μg/kg （load dose 0.2 μg/kg,infusion time 10 min）,groupⅡwere administered with dezocine m（0.1 mg/kg）,and group Ⅲ were administered with dezocine m（0.1 mg/kg）and Dexmedetomidine 0.5μg/kg（1oad dose 0.2 μg/kg,infusion time 10 min）before 15 min lumbar plexus and sciatic nerve block,re-spectively.To investigate the changes of MAP,HR,RR,SpO2 and Ramsay Sedation Score at the moment of in operating room （T0 ）, before the lumbar plexus and sciatic nerve puncture（T1 ）,A tourniquet to inflate（T2 ）,The surgery after the first 5 min （T3 ）,The surgery after 30 min （T4 ）and the end of operation （T5 ）were compared three groups.Results Three of patients in T2 time point MAP and HR were higher than other point in time,Ⅱ,Ⅲ T2 time points in the MAP belowⅠgroup,the difference was statistically significant （P 〈0.05）.GroupⅠin T1 time point HR slowed significantly,the difference was statistically significant （P 〈0.05）.The groupⅡRamsay sedation scores in T1 ~T5 point belowⅠ,Ⅲ group,the difference was statistically significant （P 〈0.05）.The post-operative VASⅡ,Ⅲ group was lower than that in groupⅠ,the difference was statistically significant （P 〈0.05）Ⅰhypotension oc-curred in 2 cases,Ⅲ group hypotension occurred in 3 patients,properly rehydration or give ephedrine 5 mg was correct.Ⅱ,Ⅲ group were 3 cases of intraoperative nausea but not vomit,relieve themselves.Three groups were not happened respiratory depression,low blood oxygen.Conclusion Dezocine and dexmedetomidine can strengthen the elderly patients with lumbar plexus and sciatic nerve block analgesia and sedation effect,no significant respiratory depression and good safety.