不同右美托咪定给药方式在子宫全切除术中的效果比较

Effect of different application ways of dexmedetomidine on epidural anesthesia in abdominal hysterectomy

目的比较右美托咪定的不同给药模式在经腹部子宫全切除术中的麻醉效果。方法选取2017年1月-2017年12月临沧市人民医院拟行经腹部子宫全切除术的66例患者作为研究对象,采用随机数字表法将患者分为硬膜外组和静脉组,各33例。硬膜外组将15ml0.75%罗哌卡因和2ml右美托咪定(1μg/kg)混合液注入硬膜外腔。静脉组在此基础上静脉输注1μg/kg右美托咪定。比较两组术前基线资料、术中资料、神经阻滞情况及不良反应发生率。结果①两组术前基线资料和术中资料比较,差异无统计学意义(P>0.05)。②两组患者的最高阻滞平面均为T5,硬膜外组的麻醉起效时间、达最高麻醉平面时间均低于静脉组(P<0.05),麻醉持续时间高于静脉组,差异有统计学意义。两组的改良Bromage分级法、Ramsay镇静评分和牵拉反应分级结果比较,差异无统计学意义(P>0.05)。③两组平均动脉压和心率指标经重复测量方差分析,其组间差异、时间差异及交互作用差异均无统计学意义(P>0.05)。④共发生低血压7例、恶心呕吐6例、寒战2例和心动过缓2例,两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论与静脉给药相比,硬膜外给予右美托咪定能显著提高罗哌卡因的硬膜外麻醉效果,起效更快、麻醉持续更久,且并未升高不良反应发生率,值得临床推广应用。

Objective To compare the effect of epidural and intravenous application of dexmedetomidine (DEX) on epidural anesthesia in abdominal hysterectomy. Methods Altogether 66 patients undergoing abdominal hysterectomy from January to December 2017 were enrolled for the study and randomly divided into epidural group and intravenous group by random number table, 33 cases for each group. Patients in epidural group were injected with 15 ml 0.75% ropivacaine and 2 ml 1 ug/kg DEX into the epidural space. Patients in intravenous group were injected with 15 ml 0.75% ropivacaine and 2 ml saline into the epidural space, and 1 ug/kg DEX through intravenous infusion. Preoperative baseline data, intraoperative data, nerve block and adverse reactions were compared between two groups. Results ① There were no significant differences between the two groups in preoperative baseline data and intraoperative data (P > 0.05).② The highest block plane of both groups was T5. The onset time of anesthesia and the time to reach the highest anesthesia plane were lower in the epidural group than those in the intravenous group (P < 0.05);the duration of anesthesia was longer than that in the intravenous group (P < 0.05). There were no significant difference between the two groups in terms of modified Bromage classification, Ramsay sedation score and traction response classification (P > 0.05).③ The mean arterial pressure and heart rate indexes of the two groups analyzed by two-factor repeated measures of variance showed no significant difference between the groups, time difference and interaction (P > 0.05).④ There were 7 cases of hypotension, 6 cases of nausea and vomiting, 2 cases of chills and 2 cases of bradycardia. There was no significant difference in the incidence of adverse reactions between two groups.(P > 0.05). Conclusions Compared with intravenous administration, epidural administration of DEX could significantly improve the effect of epidural anesthesia of ropivacaine, including faster effect-acting and longer lasting, and it did not increase the incidence of adverse reactions, so it is safe, reliable and worthy of clinical application.