右美托咪啶联合瑞芬太尼在椎体后凸术中的作用研究

Administration of dexmedetomidine along with low-dose remifentanil in patients with percutaneous kyphoplasty during surgery

目的探讨右美托咪啶联合小剂量瑞芬太尼在局麻经皮椎体后凸成形术患者中的作用研究。方法回顾性分析2016年2月至2017年12月,首都医科大学附属北京地坛医院行局部麻醉下经皮椎体后凸成形术患者66例,随机均分为右美托咪啶组(Dex组)、瑞芬太尼组(Rem组)和右美托咪啶联合瑞芬太尼组(DR组),每组22例。比较三组患者用药前(T1)、局麻时(T2)、球囊扩张时(T3)、注入骨水泥时(T4)、手术结束时(T5)的心率(heart rate,HR);平均动脉压(mean arterial pressure,MAP);脉搏氧饱和度(pulse oximetry,SpO2);Ramsay镇静评分和疼痛视觉模拟评分(visual analog scale,VAS)疼痛评分。结果DR组与Dex组、Rem组在T2~T5时HR、MAP均降低,差异有统计学意义(P<0.05),在T2时SpO2值略低,差异有统计学意义(P<0.05)。DR组与Dex组、Rem组比较在T2~T5时Ramsay评分升高(P=0.001),在T3~T5时VAS评分降低(P<0.05)。Dex组患者出现不良反应15例(68.18%),Rem组13例(59.09%),DR组4例(18.18%),差异有统计学意义(χ^2=12.496,P=0.002)。结论右美托咪啶联合小剂量瑞芬太尼在局麻经皮椎体后凸成形术患者中效果确切,减少手术期应激反应,有良好安全的镇痛和镇静作用。

Objective To discuss the effect and safety of combined use of dexmedetomidine with low-dose remifentanil in patients with percutaneous kyphoplasty for local anesthesia during surgery.Methods 66 patients underwent percutaneous kyphoplasty in our hospital from Feb.2016 to Dec.2017 were enrolled in the study and randomly divided into dexmedetomidine(Dex)group,remifentanil(Rem)group and dexmedetomidine combined with low dose remifentanil(DR)group,with 22 cases in each group.Heart rate(HR),mean arterial pressure(MAP),pulse oxygen saturation(SpO2),Ramsay sedation score and visual analog scale(VAS)pain score were recorded and evaluated at the time points of pre drug administration(T1),post anesthesia(T2),balloon dilatation(T3),bone cement(T4),end of surgery(T5),and were compared among subjects in 3 groups.Results The HR and MAP at T2-T5 were significantly reduced in DR group compared to Dex group and Rem group(P<0.05),and the SpO2 was also lower at T2(P<0.05).The Ramsay scores at T2-T5 in DR group were significantly higher than those in Dex group and Rem group(P=0.001),while the VAS scores at T3-T5 were significantly lower(P<0.05).More cases in Dex group(15 cases,68.18%)and Rem group(13 cases,59.09%)experienced adverse reactions of drugs compared to those in DR group(4 cases,18.18%),the difference was statistically significant(χ^2=12.496,P=0.002).Conclusions Administration of dexmedetomidine along with low-dose remifentanil in patients with posterior percutaneous kyphoplasty may reduce the perioperative stress response and exert excellent analgesic and sedative effects.