右旋美托咪啶复合罗哌卡因硬膜外麻醉在妇科手术患者中的应用

Application Of Epidural Anesthesia Compound Dexmedetomidine With Ropivacaine On Patients Undergoing Gynecologic Surgery

目的：观察罗哌卡因复合右旋美托咪啶（Dexmedetomidine,DMED）硬膜外麻醉对于阴式全子宫切除患者手术的麻醉效果及应用价值研究。方法：纳入研究60例择期手术患者（ASAⅠ~Ⅱ级）,随机分为罗哌卡因硬膜外麻醉组（L组,n=30）和右旋美托咪啶复合罗哌卡因硬膜外组（D组,n=30）。对照组（L组）试验量后硬膜外隙注入0.596%罗哌卡因总量14 ml加生理盐水1 ml,D组硬膜外隙注入0.596%罗哌卡因14 ml加右旋美托咪啶0.5μg/kg（1 ml）。记录患者年龄、身高、体重、ASA分级、手术时间、失血量和输液量等一般情况;连续监测Bp,HR,Sp O2和RR,记录感觉阻滞和运动阻滞开始时间、麻醉维持时间、达到最高阻滞平面的时间和术后镇痛维持时间等情况,从镇痛,肌肉松弛和牵拉反应方面评估麻醉效果,观察围术期心动过缓,低血压、恶心、呕吐和寒战等不良反应的发生。结果：D组的感觉阻滞起效时间,达到最高阻滞平面时间均明显短于L组,差异有统计学意义（P〈0.05）,D组麻醉维持时间和镇痛时间长于L组,差异有统计学意义（P〈0.05）,而不良反应的发生情况和患者一般情况两组比较,差异无统计学意义（P〉0.05）。结论：罗哌卡因复合右旋美托咪啶硬膜外麻醉可延长感觉阻滞维持时间和镇痛时间,麻醉效果更完善,且安全。

Objective To observe the efficacy and safety of ropivacaine combined with dexmedetomidine epidural anesthesia for Gynecologic Surgery. Method 60 cases of elective surgery patients （ASA I - II grade） were included in the study. They were randomly divided into 2 groups （n = 30 ） ： Ropivacaine group （group L） and group dexmedetomidine ＆ Ropivacaine （group D, n = 30）. Normal saline 1 ml or dexmedetomidine 0. 5 μg/kg （1 ml） plus ropivacaine were administrated in group L and group D respectively. Bp,HR, SpO2 and RR were recorded, sensory and motor blockade, the perioperative adverse reaction were observed. Results Compared with group L, the onset time of sensory block and achieved the highest block level were significantly shorter in group D,the difference was statistically significant （P 〈0. 05）. The effects of anesthesia in group D was better than that in group L, the difference was statistically significant （ P 〈 0. 05 ）. there were no significant differences in the perioperative adverse reaction between the two groups （ P 〉 0. 05 ）. Conclusion Epidural anesthesia with ropivacaine plus dexmedetomidine for Gynecologic Surgery is effective and safe.