腰硬联合麻醉下肢手术患者应用不同剂量右美托咪定的镇静效果观察

Sedative effect of different doses of dexmedetomidine in patients undergoing lower limb surgery under combined spinal epidural anesthesia

目的探讨不同剂量右美托咪定在腰硬联合麻醉下肢手术患者中应用的镇静效果。方法选择84例在CSEA下行下肢手术患者,随机分成A1、A2、A3和B组共四组,每组各21例。其中,A1组～A3组患者分别注射Dex 0.25、0.5和0.75μg/(kg·h),B组患者注射NS。记录比较4组患者用药后各时间点HR、MAP及Ramsay评分数值变化。结果 A1～A3组患者HR在T3～T5比T0和B组下降(P<0.05);A1～A3组患者MAP在T1、T2比T0明显升高(P<0.05);A1、A3组患者MAP在T3、T4时间点较T0降低(P<0.05);Ramsay评分A1～A3组在T2～T5时间点镇静满意例数多于B组(P<0.05),A2组在同一时间点镇静满意患者的例数明显多于A1组和A3组。结论 CSEA下肢手术患者静注Dex 0.5μg/(kg·h)较其他剂量Dex的镇静效果更满意,患者术中HR、MAP更稳定。

Objective To investigate the sedative effect of different doses of dexmedetomidine （Dexmedetomidine,Dex） in patients undergoing lower limb surgery with combined spinal epidural anesthesia （CSEA）. Methods 84 cases of patients with CSEA in lower limb surgery were selected and randomly divided into 4 groups,A1,A2,A3 and B group,21 cases in each group. Among them,patients in group A1-A3 were injected with 0.25,0.5 and 0.75 μL g/（kg·h）.Patients in group B were injected with NS.,and the changes of HR,MAP and Ramsay seores at each time point after treatment were compared between the 4 groups. Results In A1-A3 group,the HR in T3-T5 was lower than that in TO and B gronp （P 〈 0.05）;In A1-A3 group,the MAP in TO and T2 was significantly higher than lhat in T1 group（P 〈 0.05）;In group A1 and group A3,MAP were decreased at T3 and T4 time points compared with TO （P〈 0.05）.in Ramsay scores, sedation satisfaction cases of A1-A3 group in T2-T5 time point were more than B group （P 〈 0.05）.The number of patients with sedation satisfaction in group A2 at the same time point was significantly more than that in group A1 and group A3. Conclusion intravenous injection Dex of 0.5 μL g（kg·h） in patients undergoing lower limb surgery was more satisfactory than other doses of Dex sedation, and HR and MAP were more stable in patients undergoing lower extremity surgery.