不同剂量右美托咪定预防硬膜外麻醉下阑尾切除术牵拉反应的效果

Effect of Different-Doses of Dexemedetomidine on Prevention of Visceral Traction Response During Appendectomy with Epidural Anesthesia

目的 观察不同剂量右美托咪定（DEX）预防硬膜外麻醉下阑尾切除术牵拉反应的效果.方法 选择在硬膜外麻醉下行急性阑尾切除术患者80例（ASAⅠ-Ⅱ级）,随机分成4组（D1组、D2组、D3组和C组）,每组20例.硬膜外麻醉平面固定后,D1组、D2组和D3组分别静脉泵注负荷剂量DEX 0.3,0.5,0.7μg/kg,输注的时间均为10 min,随后分别静脉泵注DEX 0.3,0.5,0.7μg/（kg？h）至术毕;C组静脉泵注生理盐水10 mL/h至术毕.记录T0~T5时点的HR、MAP、SpO2和BR;在T0、T2~T5等时点对患者进行Ramsay镇静评分;评估患者预防牵拉反应的效果;观察患者不良反应的发生情况.结果 在T2~T5时点,D2组和D3组的HR明显慢于C组,MAP明显低于C组,Ramsay镇静评分明显高于C组（P〈0.05）;D1组、D2组和D3组预防牵拉反应效果的达优率明显高于C组（P〈0.05）;D3组心动过缓的发生率明显高于D1组、D2组和C组（P〈0.05）,D1组、D2组和D3组寒战和恶心呕吐的发生率明显低于C组（P〈0.05）.结论 DEX在硬膜外麻醉下行阑尾切除术的患者中应用,能有效预防术中牵拉反应,满足手术的镇静需求,减少恶心呕吐、寒战等不良反应,其推荐最佳剂量为DEX负荷剂量0.5μg/kg,随后以0.5μg/（kg？h）维持.

Objective To observe the effects of different-doses of dexemedetomidine on prevention of visceral traction response during appendectomy with epidural anesthesia. Methods Eighty ASA grade Ⅰ-Ⅱ level patients, undergoing appendectomy with epidural anesthesia, were divided randomly into four groups： group D1, D2, D3, C, with 20 cases each. After the plane was fixed, dexmedetomidine was respectively administrated a loading dose of 0.3, 0.5 and 0.7 μg/kg which was infused intravenously over 10 minutes before induction, and was infused intravenously with the continuous dose of 0.3, 0.5 and 0.7 μg/（kg？h） during operations respectively in group D1, D2, D3. Normal saline was infused intravenously with 10 mL/h during operations in group C. It was recorded by HR, MAP, SpO2, BR at T0~T5. Ramsay sedation score was conducted at T0, T2~T5. The effects of preventing visceral traction response were evaluated. The occurrence of adverse reactions were observed. Results At T2~T5, the changes of HR in group D2 and D3 were extremely slower than that in group C, the changes of MAP in group D2 and D3 were obviously lower than that in group C, the Ramsay sedation score in group D2 and D3 were remarkably higher than that in group C （P〈0.05）. The effects of preventing visceral traction response in group D1, D2 and D3 were apparently better than that in group C （P〈0.05）. The incidence of bradyarrhythmia in group D3 was extremely higher than that in group D1, D2 and C. The incidence of chills, nausea and vomiting in group D1, D2 and D3 was obviously lower than that in group C （P〈0.05）. Conclusion Dexmedetomidine, which is used in appendectomy with epidural anesthesia, can effectively prevent visceral traction response, meet the sedation needs during the operation, and reduce adverse reactions such as chills, nausea and vomiting. The way dexmedetomidine administrated is a loading dose of 0.5 μg/kg and is infused intravenously with the continuous dose of 0.5 μg/（kg？h） during operations is recommended.