术中应用右美托咪定对女性患者急性创伤后应激障碍的影响

Effect of intraoperative application of dexmedetomidine on acute post-traumatic stress disorder in fe-male patients

目的评价术中应用右美托咪定对女性患者急性创伤后应激障碍的影响。方法行骨折复位内固定术的交通意外下肢骨折的女性患者90例，ASA分级I或Ⅱ级，年龄20～35岁，体重40～72kg，采用随机数字表法分为3组：对照组（C组）、低剂量右美托咪定组（D．组）和高剂量右美托咪定组（D：组），每组30例。硬膜外腔注射0．75％罗哌卡因10～15ml，测定痛觉消失平面在T。。水平后开始手术；间断注射2％利多卡因5～10ml维持麻醉平面在T。硬膜外麻醉成功后，D，组和D：组分别经30min静脉输注右美托咪定0．5和1．0μg／kg，C组输注等容量生理盐水。术后采用0．15％罗哌卡因行自控硬膜外镇痛至术后48h，维持VAS评分≤3分。VAS评分〉3分时，静脉注射吗啡3mg补救镇痛。记录术后48h内镇痛补救情况；分别于术前1h、术后1、3及7d时行急性应激反应量表（ASDS）评分、焦虑自评量表（SAS）评分及抑郁自评量表（SDS）评分；术后3个月，电话随访行创伤后应激障碍筛查量表一平民版评分，记录急性创伤后应激障碍（创伤后应激障碍筛查量表一平民版评分〉38分）的发生情况。结果与C组比较，D．组和D，组术后i、3和7d时ASDS评分、SAS评分和SDS评分降低，急性创伤后应激障碍发生率降低（P〈0．05）；与D，组比较，D，组术后1、3和7d时AS—Ds评分降低，急性创伤后应激障碍发生率降低（P〈0．05），各时点SAS评分及SDS评分差异无统计学意义（P〉0．05）。3组间术后镇痛补救率差异无统计学意义（P〉0．05）。结论术中应用右美托咪定可减少女性患者急性创伤后应激障碍的发生，且与剂量有关。

Objective To evaluate the effect of intraoperative application of dexmedetomidine on a- cute post-traumatic stress disorder （PTSD） in female patients with lower limb fracture. Methods Ninety female patients with lower limb fractures caused by traffic accident, of American Society of Anesthesiologists physical status I or II , aged 20-35 yr, weighing 40-72 kg, scheduled for elective internal fixation, were divided into 3 groups （n= 30 each） using a random number table： control group （group C）, low-dose dexmedetomidine group （group D~ ） and high-dose dexmedetomidine group （group D2 ）. Ropivacaine （0.75%） 10-15 ml was injected into the epidural space, and operation was started after pain disappeared at the plane Ts_lo. Two percent lidoeaine 5- 10 ml was intermittently injected to maintain the anesthetic plane at Tlo. After successful epidural anesthesia, dexmedetomidine 0. 5 and 1.0 p^g/kg were intravenously infused over 30 min in D1 and D2 groups, respectively, while the equal volume of normal saline was given in group C. Patient-controlled epidural analgesia was performed with 0. 15% ropivacaine after operation andlasted until 48 h postoperatively, maintaining visual analogue scale score ~3 （baseline）. Morphine 3 mg was intravenously injected for rescue analgesia when visual analogue scale score〉3. The requirement for res- cue analgesia within 48 h after operation was recorded. Acute Stress Disorder Scale （ ASDS）, Self-Rating Anxiety Scale （SAS） and Self-rating Depression Scale （SDS） scores were assessed at 1 h before operatiof~ and on 1, 3 and 7 days after operation. The patients were followed up for 3 months by telephone, and the PTSD Checklist-Civilian Version score was evaluated. The occurrence of acute PTSD （PTSD Checklist-Ci- vilian Version score 〉 38） was recorded. Results Compared with group C, the ASDS, SAS and SDS scores were significantly decreased on 1, 3 and 7 days after operation, and the incidence of acute PTSD was decreased in D~ and D2 groups （P〈0. 05）. Compared with group D~, the ASDS scores were signifi- cantly decreased on 1, 3 and 7 days after operation, and the incidence of acute PTSD was decreased （P〈 0. 05）, and no significant change was found in SAS or SDS scores at each time point in group D2 （P〉 0. 05 ）. There was no significant difference in the requirement for rescue analgesia between the three groups （ P〉0. 05）. Conclusion Intraoperative application of dexmedetomidine can reduce the occurrence of acute PTSD and it is dose-related in female patients.