右美托咪定硬膜外麻醉效果及唤醒时间的研究

Study on epidural anesthesia and arousal time from dexmedetomidine in lower abdominal surgery

目的:研究右美托咪定在下腹部手术硬膜外麻醉的效果及唤醒时间。方法 :选取2015年1月至2016年1月我院收治的120例下腹部手术硬膜外麻醉病人,分成研究组和对照组,每组各60例。研究组给予右美托咪定麻醉,对照组给予可乐定麻醉。研究两组病人不同时间段的心率和平均动脉压情况以及Ramsay镇静评分、唤醒时间和不良反应。结果:研究组病人心率和给药后15 min的平均动脉压显著低于对照组(P=0.021和P=0.033),其他时间段无统计学差异(P>0.05)。两组病人不同时间段Ramsay镇静评分无统计学差异(P>0.05)。研究组病人术中脑电双频指数(bispectral index,BIS)评分显著低于对照组病人(P<0.05)。研究组病人唤醒时间、BIS达90所需时间及视觉模拟评分显著低于对照组病人[(37.3±2.4)min、(39.1±5.1)min和(3.2±1.1)分比(57.3±4.1)min、(58.2±3.2)min和(4.2±1.2)分,P<0.001],术后疼痛发生时间显著迟于对照组病人[(198.2±33.2)min比(150.1±28.5)min,P<0.001]。两组病人不良反应,包括心动过缓、低血压、恶心呕吐、寒战及呼吸抑制等无统计学差异(P>0.05)。结论:右美托咪定在下腹部手术硬膜外麻醉中具有较好的镇静和镇痛效果,且唤醒时间短,未增加不良反应,值得临床应用。

Objective To study on epidural anesthesia and arousal time from dexmedetomidine in lower abdominal surgery. Methods A total of 120 cases with lower abdominal surgery under epidural anesthesia in our hospital were divi- ded into study group and control group from January 2015 to January 2016. Patients in study group received dexmedeto- midine anesthesia, and those in control group received clonidine anesthesia. The heart rate, mean arterial pressure, Ram- say sedation score, wakeup time and adverse reactions in different time segments between two groups were compared. Results The heart rate and mean arterial pressure at 15 min after loading dose in study group were lower than in control group （P=0.021 and P=0.033）. No statistically significant difference was found at other time （P〉0.05）. The difference of Ramsay sedation score between two groups was not statistically significant （P〉0.05）. Bispectral index （BIS） in study group was significantly lower than that in control group （P〈0.05）. Arousal time, time for BIS to 90 and visual blur score of the patients in study group were significantly less than those in control group[（37.3±2.4） min, （39.1±5.1） rain and （3.2±1.1） vs. （57.3±4.1） min, （58.2±3.2） rain and （4.2±1.2）, P〈0.001]. Postoperative pain in study group[（198.2±33.2） min] delayed sig- nificantly compared with those in control group [（150.1±28.5） rain] （P〈0.001）. The adverse reactions include bradycardia, hy- potension, nausea and vomiting, chills, and respiratory depression had no significant difference statistically in two groups （P〉0.05）. Conclusions Dexmedetomidine has better sedation and analgesia, shorter arousal time in lower abdominal surgery with epidural anesthesia, and does not increase the incidence of adverse reactions. The clinical application would be recommended.