羟考酮联合右美托咪定用于老年患者椎体成形术麻醉效果

Clinical effects of oxycodone combined with dexmedetomidine in percutaneous vertebroplasty for patients undergoing MAC anesthesia

目的观察羟考酮联合右美托咪定用于老年患者椎体成形术监测麻醉(MAC)的临床效果。方法选择2016年2—8月解放军307医院骨科收治的因骨质疏松致椎体压缩性骨折行椎体成形术的老年患者60例为研究对象,采用随机数字表法分为A组(舒芬太尼+右美托咪定组)与B组(羟考酮+右美托咪定组),每组30例。两组患者均采用静脉注射右美托咪定镇静,A组给予舒芬太尼0.08μg/kg镇痛,B组给予羟考酮0.08 mg/kg镇痛。记录两组患者手术时间、右美托咪定总用量、苏醒时间。记录静注右美托咪定(T_0)、改为俯卧位(T_1)、手术开始(T_2)、穿刺椎体(T_3)、术中任意3次均值(T_4)、苏醒(T_5)6个时点的心率(HR)、收缩压(SBP)、脉搏氧饱和度(SpO_2)、视觉模拟疼痛评分法(VAS)评分。记录两组患者术中麻醉效果、患者满意度及不良反应发生率。结果两组患者各时点的HR、SBP、SpO_2比较,差异均无统计学意义(P>0.05);B组T_2、T_3时点VAS评分低于A组,术中麻醉效果及患者满意度均优于A组,右美托咪定用量明显少于A组,不良反应发生率低于A组,差异均有统计学意义(P<0.05)。结论羟考酮联合右美托咪定用于老年患者椎体成形术MAC麻醉安全可行,血流动力学稳定,麻醉效果佳,不良反应少。

Objective To observe the clinical effects ofoxycodone combined with dexmedetomidine in percutaneous vertebroplasty for patients undergoing MAC anesthesia. Methods A retrospective study was performed on 60 cases of patients undergoing percutaneous vertebroplasty from February to August 2016. Patients were randomly divided into Group A（ sufentanil ＋ dexmedetomidine） and Group B（ oxycodone ＋ dexmedetomidine）,with 30 cases in each group. Dexmedetomidine was infused in turn for sedationineach group. Sufentanil 0. 08 μg/kg was infused for patients of Group A,oxycodone 0. 08 mg/kg was infused for patients of Group B. The operation time of the two groups of patients,the total dosage of dexmedetomidine and the wake time were recorded. Dexmedetomidine（ T0）,instead of prone position（ T1）,surgerystarted（ T2）,puncture vertebral bodies（ T3）,mean intraoperative any 3 times（ T4）,wake up（ T5） six points of heart rate（ HR）,systolic blood pressure（ SBP）,pulse oxygen saturation（ SpO2） and visual analog pain score（ VAS） score were recorded. The anesthetic effect,patient satisfaction and adverse reaction rate were recorded in the two groups. Results There were no differences between the two groups of HR,SBP and SpO2（ P〉0. 05）. In Group B,VAS score at T2 and T3 were lower than those in Group A,intraoperative anesthetic effect and patient satisfaction were superior to Group A,the dexmedetomidine fixed dosage was significantly less than that in Group A,the incidence of adverse reactions were lower than that in Group A,and the differences were statistically significant（ P〈0. 05）. Conclusion Oxycodone combined with dexmedetomidine in percutaneous vertebroplasty for patients undergoing MAC anesthesia is safe and fexiable with stable hemodynamics,better effect of anesthesia and less adverse reactions.