老年患者腰硬联合麻醉下全髋关节置换术中应用右美托咪定鞘内注射的临床效果观察

Clinical observation of intrathecal dexmedetomidine in aged patients undergoing total hip replacement after combined spinal-epidural anesthesia

目的评估右美托咪定鞘内注射用于老年患者腰硬联合麻醉下全髋关节置换术的麻醉效果。方法选择2017年8月至2018年3月在本院择期行腰硬联合麻醉下全髋关节置换术的老年患者80例,随机分为右美托咪定组(观察组)和对照组,每组40例。观察组患者腰硬联合麻醉腰麻时鞘内注入等比重0.5%布比卡因12.5mg(2.5ml)+右美托咪定5μg(用生理盐水稀释至0.5ml),对照组患者鞘内注入等比重0.5%布比卡因12.5mg(2.5ml)+生理盐水0.5ml。记录麻醉前及麻醉后平卧5、10、20、30、60分钟时的收缩压、舒张压和心率变化,感觉和运动阻滞起效时间及持续时间,术后疼痛及围术期不良反应情况。结果两组麻醉前后各时间点收缩压、舒张压和心率比较差异均无显著性(P>0.05)。与对照组相比,观察组患者感觉和运动阻滞起效时间缩短,持续时间延长(P<0.05)。两组围术期不良反应比较差异无显著性(P>0.05),但观察组患者术后疼痛评分及24小时吗啡用量明显低于对照组(P<0.05)。结论对于老年全髋关节置换患者,右美托咪定复合布比卡因鞘内注射行腰硬联合麻醉能缩短感觉和运动阻滞的起效时间,并延长其持续时间,增强麻醉效果,提高后镇痛质量,但须警惕心动过缓的发生。

Objective To evaluate the efficacy of intrathecal dexmedetomidine as an adjuvant to bupivacaine in combined spinal-epidural anesthesia in aged patients undergoing total hip replacement. Method A total of 80 aged patients who underwent CSEA for elective total hip replacement were randomly divided into a dexmedetomidine group（group D） and a control group（group S）, each group with 40 patients. Patients in group D were allocated to receive dexmedetomidine 5 μg diluted in 0.5 ml normal saline added to 12.5 mg（2.5 ml） of 0.5% isobaric bupivacaine; Patients in group S were received 0.5 ml normal saline added to 12.5 mg of 0.5% isobaric bupivacaine. The SBP, DBP, HR before anesthesia and 5, 10, 20, 30, 60 min after anesthesia were recorded. The data of the onset and duration of sensory block, motor block and duration were recorded. The intraoperative adverse reactions and postoperative VAS scores were recorded. Result Compared with the group S, onset of sensory block and motor block in group D were significantly lower（P〈0.05）, duration of sensory block and motor block in group D were significantly longer（P〈0.05）, the postoperative VAS scores were lower（P〈0.05）. Conclusion For the elderly patients undergoing total hip replacement after combined spinal-epidural anesthesia, intrathecal dexmedetomidine can shorten the onset time of sensory block and motor block, prolong the duration of sensory block and motor block, enhance the effect of anesthesia and the quality of postoperative analgesia, but the occurrence of bradycardia must be vigilant.