右美托咪定两种给药模式在老年膝关节镜手术腰硬联合麻醉中的应用效果及安全性分析

Analysis of Efficacy and Safety of Two Medication Methodes of Dexmedetomidine in Combined Spinal Epidural Anesthesia for Elderly Patients with Knee Arthroscopic Surgery

目的观察老年膝关节镜手术腰硬联合麻醉中静脉泵注和自控镇静模式应用右美托咪定的效果及安全性。方法选取解放军188医院于2015年1月—2016年6月行膝关节镜手术患者80例,采用随机数字表法将其分为两组,均行腰硬联合麻醉,常规组术中应用静脉泵注右美托咪定,研究组则采用电子自控镇静模式应用右美托咪定,观察两组患者感觉、运动阻滞的起效和恢复时间,镇静效果,不良反应及术后遗忘情况。结果研究组感觉及运动阻滞的起效时间明显短于常规组(P<0.01),且恢复时间明显长于常规组(P<0.01)。研究组达适宜镇静时间明显长于常规组(P<0.01),达适宜镇静和术毕时右美托咪定用量明显少于常规组(P<0.05,P<0.01)。两组术中均未出现寒战、低血压、心动过缓等不良反应。两组术后躁动和遗忘程度比较差异无统计学意义(P>0.05)。结论老年膝关节镜手术腰硬联合麻醉中应用右美托咪定自控镇静模式可达到静脉泵注的镇痛效果,维持时间较长且用药剂量较少,不良反应少且轻微,是一种较为理想的镇静模式。

Objective To compare efficacy and safety of intravenous infusion and patient-controlled sedation method with Dexmedetomidine in combined spinal epidural anesthesia for elderly patients with knee arthroscopic surgery. Methods A total of 80 patients undergoing knee arthroscopic surgery during January 2015 and June 2016 were divided into 2 groups by random digits table method, and all patients were treated with combined spinal epidural anesthesia. Rou- tine group was treated with Dexmedetomidine by venous pump, while study group used electronic patient-controlled seda- tion with Dexmedetomidine. Feeling, onset and recovery time of movement block, sedative effect, adverse reaction and postoperative amnesia conditions were observed. Results In study group, values of feeling and onset time of movement block were significantly lower （ P 〈 0. 01 ）, and the recovery time of movement block was significantly longer than that in routine group （ P 〈 0. 01 ） ; appropriate sedation time was significantly longer than that in routine group （ P 〈 0. 01 ）, but Dexmedetomidine doses at appropriate sedation and at the end of surgery were significantly less than those in routine group （P 〈 0. 05, P 〈 0. 01 ）. No adverse reactions such as shivering, hypotension and bradycardia were found in two groups. There were no significant differences in postoperative agitation and degree of forgetting in two groups （P 〉0. 05）. Conclusion Patient-controlled sedation method with Dexmedetomidine in combined spinal epidural anesthesia for elderly pa- tients with knee arthroscopic surgery can achieve similarly analgesic effect of intravenous infusion, and it has longer hold time and less dosage and slight adverse reactions.