右美托咪定在经皮球囊扩张椎体后凸成形术麻醉中的应用

Application of dexmedetomidine in anesthesia of percutaneous kyphoplasty operation

目的观察在经皮球囊扩张椎体后凸成形术(PKP)麻醉中使用右美托咪定对患者血流动力学、疼痛程度及呼吸的影响。方法选取2017年1—9月于北京市和平里医院择期行PKP的患者54例,根据随机数字表法分为对照组、咪达唑仑组、右美托咪定组,各18例。入室开放静脉后,3组均静脉给予舒芬太尼0.08μg/kg。俯卧位后,对照组给予0.9%氯化钠注射液;咪达唑仑组给予咪达唑仑初始负荷剂量0.02 mg/kg静脉推注,后以0.02 mg/(kg·h)持续静脉泵注;右美托咪定组给予右美托咪定初始负荷剂量0.6μg/kg静脉泵注10 min,维持量为0.3μg/(kg·h);3组均在骨水泥凝固拔出工作套管后停用药物。记录并比较3组入室5 min后(T_1)、浸润麻醉前(T_2)、工作套管到位注射骨水泥前(T_3)、骨水泥凝固拔出工作套管后(T_4)、患者术毕后5 min时(T_5)的平均动脉压(MAP)、心率变化以及疼痛视觉模拟量表(VAS)评分;记录术中呼吸抑制的发生情况。结果 T_1时3组间MAP、心率、VAS评分差异无统计学意义(P>0.05)。T_2～T_5时右美托咪定组MAP、心率明显均低于对照组和咪达唑仑组,差异有统计学意义(P<0.05)。T_2～T_5时右美托咪定组VAS评分明显低于对照组和咪达唑仑组,差异有统计学意义(P<0.01)。咪达唑仑组呼吸抑制发生率[38.9%(7/18)]明显高于其他2组[0.0%(0/18)、0.0%(0/18)],差异有统计学意义(P<0.01)。结论 PKP术中使用右美托咪定镇静,兼备止痛作用,能够提供较佳的围术期镇静及镇痛效果,且不抑制呼吸,不影响术中医患交流,是一种安全有效的镇静方法。

Objective To observe the effect of dexmedetomidine on hemodynamics, pain and respiration during percutaneous kyphoplasty（PKP）. Methods A total of 54 patients undergoing PKP from January to September 2017 in Beijing Hepingli Hospital were randomly divided into control group, midazolam group and dexmedetomidine group, with 18 cases in each group. All patients had intravenous injection of sulfentanyl 0. 08 μg/kg; the control group was injected 0. 9% sodium chloride solution ; the midazolam group was injected midazolam [ initial dose ： 0. 02 mg/kg, maintenance dose： 0. 02 mg/（ kg. h） ] ; the dexmedetomidine group was injected dexmedetomidine [ initial dose： 0. 6 μg/kg, maintenance dose： 0. 3 μg/（ kg h）. Drug administration was withdrawn after bone cement solidification. Mean arterial pressure（MAP） , heart rate（HR） and the Visual Analogue Scale（VAS） score were recorded before operation（T1 ）, before local anesthesia（T2 ）, before bone cement injection（T3 ）, after bone cement solidification （ T4 ） and 5 min after operation （ T5 ）. Occurrence of respiratory depression was observed during operation. Results There were no significant differences of MAP, HR and VAS score at T1 anlong groups （ P 〉 0. 05 ）. MAP and HR at T2-T5, in dcxmedetomidine group were significantly lower than those in eontrol group and midazolam group（P 〈 0. 05）. VAS scores at T2-T5 in dexmedetomidine group were signifieantly lower than those in control group and midazolam group （ P 〈 0. 01 ）. Incidence of respiratory depression in midazolam group was significantly higher than that in control group and dexmedetomidine group[ 38. 9% （7/18） vs 0. 0% （0/18）, 0. 0% （0/18）] （P 〈0. 01 ）. Conclusion Dexmedetomidine has good sedative and analgesie effects on patients undergoing PKP with no respiratory depression.