不同剂量右美托咪定对腰-硬联合麻醉下高龄患者下腹部手术的影响

Effect of dexmedetomidine in the elderly patients at combined spinal-epidural anesthesia with lower abdominal surgery

目的：探讨不同剂量右美托咪定对腰-硬联合麻醉下高龄患者下腹部手术的镇静效果的影响。方法：选取年龄≥65岁的腰-硬联合麻醉下行腹部手术的患者120例,随机分为右美托咪定组（D1、D2、D3组）及咪达唑仑组（M组）。分别记录患者麻醉前（T0）、用药后5 min（T1）、30 min（T2）、60 min（T3）Ramsay评分及记录术中、术后出现不良反应的例数。结果：D1、D2、D3组及M组在T1~T3时Ramsay评分显著高于同组T0时的评分,差异有统计学意义（P〈0.05）;在T1-T3时,D2、D3的Ramsay评分均高于M组,差异有统计学意义（P〈0.05）;与M组相比,D1、D2、D3组的不良反应（心动过缓、恶心呕吐）显著减少,差异有统计学意义（P〈0.05）。结论：右美托咪定辅助高龄患者腰-硬联合麻醉下腹部手术时可产生理想镇静状态,其不良反应较少,其中以0.3~0.5μg/kg为初始剂量,以0.3μg/（kg·h）进行维持为宜。

Objective To investigate the effect of different doses of dexmedetomidine in the elderly patients at combined spi- nal - epidural anesthesia with lower abdominal surgery. Method 120 elderly patients at combined spinal - epidural anesthesia with lower abdominal surgery were chosen into DEX group（ group D1 ,D2 ,D3 ）and midazolam group. Ramsay sedation score were evaluated at time points of before（ T0 ） ,5 min（ T1 ） ,30 rain （T2 ） ,60 min（ T3 ） after treatment. The side effects in these patients were also recorded. Results Compared with TO in all group, ramsay sedation score increased significantly at T1 - T3 , the difference was statistically significant （P 〈 0. 05）. In group D2 and D3, ramsay sedation score were increased significantly at T1 - T3 com- pared with group M, the difference was statistically significant （P 〈 0. 05 ）. The side effect （ bradycardia, nausea and vomiting） were more happened in group M, the difference was statistically significant （ P 〈 0. 05 ）. Conclusion For the elderly Patients at combined spinal - epidural anesthesia with lower abdominal surgery, appropriate dose of DEX caused effective sedation. Intravenous injection DEX 0. 3 - 0. 5 μg/kg with 5 minutes followed by maintenance infusion of 0. 3 μg/kg is suggested.