静脉给予右美托咪定与丙泊酚用于蛛网膜下腔麻醉中度镇静的临床效果比较

Comparison of Clinical Efficacy of Intravenous Dexmedetomidine and Propofol for Moderate Sedation during Spinal Anesthesia

目的评估并比较静脉给予右美托咪定与丙泊酚用于蛛网膜下腔麻醉中度镇静的临床效果。方法选取2014年6月至2016年11月于我院拟行蛛网膜下腔麻醉下手术患者126例为本研究试验对象,随机分为A、B和C组,每组各42例。A组患者给予首剂量1μg/kg右美托咪定,缓慢静注10min以上,继以0.5μg/kg/h维持麻醉;B组给予首剂量1mg/kg丙泊酚,静注10min以上,随后以2mg/kg/h维持麻醉;C组仅静注NaCl注射液。记录患者的有效麻醉持续时间、改良OAA/S评分恢复至4以上所需时间及患者的术中/术后不良反应,并评估患者的整体满意度。结果 A组患者恢复至OAA/S≥4所需时间(27.05±2.25vs 15.26±1.88和3.88±1.78min,P=0.01)及有效麻醉持续时间(225.52±5.60vs 139.59±3.02和138.42±4.95min,P=0.03)显著长于B、C两组。A组与B组相比表现更为深度的镇静水平,且A组的3级满意度比例明显高于B、C两组(77.5%vs 55.5%和37.5%,P=0.04)。三组的各项不良反应指标均无显著统计学差异。结论与丙泊酚相比,右美托咪定在蛛网膜下腔麻醉中的中度镇静作用效果更显著且患者满意度更高。

Objective To compare the clinical efficacy of intravenous dexmedetomidine and propofol for moderate se-dation during spinal anesthesia.Methods 126 patients posted for surgeries under spinal anesthesia in our hospital from June 2014 to December 2016 were chosen in this study,and randomly divided into group A,B and C with each group 42 patients.Patients in group A received an initial dose of 1 μg/kg dexmedetomidine infused over 10 min,followed by ma-intenance of 0.5 μg/kg/h;patients in group B received an initial dose of 6 mg/kg/h propofol infused over 10 min fol-lowed by maintenance of 2.5 mg/kg/h;patients in group C received only normal saline infusion.Duration of effective analgesia,time to return to sedation score 4 on modified OAA/S scale after stopping the infusion of study drugs,and the adverse effects both intraoperatively and postoperatively were recorded.The overall satisfaction of patients was also as-sessed.Results The time to return to sedation score 4 on modified OAA/S scale（27.05 ±2.25 vs 15.26 ± 1.88 and 3.88±1.78 min,P =0.01）and duration of effective analgesia（225.52±5.60 vs 139.59±3.02 and 138.42±4.95 min, P =0.03）in group A were significantly longer than that in group B.Group A had the deeper sedation level and higher o-verall patient＇s satisfaction（77.5% vs 55.5% and 37.5%,P =0.04）compared to group B and C.No significant differ-ence exited in each adverse effect between three groups.Conclusion Compared to propofol,dexmedetomidine has better moderate sedation and higher patient＇s satisfaction for surgeries under spinal anesthesia.