小剂量右美托咪定复合罗哌卡因在老年患者TURP手术中的应用

Application of low dose dexmedetomidine combined with ropivacaine in elderly patients during TURP surgery

目的探讨小剂量右美托咪定复合小剂量罗哌卡因实施脊髓麻醉在老年患者经尿道前列腺电切术(transurethral resection of prostate,TURP)手术中的应用。方法选择择期行TURP的老年患者60例,随机分为D组和R组,每组30例,D组鞘内注射盐酸右美托咪定5μg复合0.5%盐酸罗哌卡因10 mg,R组鞘内注射0.5%盐酸罗哌卡因10 mg。监测术中无创平均动脉压(MAP)、心率(HR)和脉搏血氧饱和度(SpO_(2))。记录感觉、运动阻滞的起效时间和持续时间,术后VAS评分,术后镇痛药的需求情况,以及恶心、呕吐、低血压、心动过缓等不良反应发生情况。结果两组患者MAP、HR及SpO_(2)无明显差异(P>0.05)。在感觉阻滞起效时间上,D组与R组不具有统计学差异(P>0.05)。D组与R组相比,感觉阻滞最高平面存在差异(P<0.05);在感觉阻滞持续时间方面,R组感觉阻滞消退2个节段的时间[(89.3±6.5)min]比D组[(111.2±38.1)min]更早(P<0.05),同时,D组的感觉阻滞持续时间[(286.7±43.2)min]更久(P<0.05)。在运动阻滞方面,D组的运动阻滞起效时间[(3.2±0.8)min]比R组[(3.9±1.3)min]更短(P<0.05);运动阻滞持续时间D组[(242.7±33.7)min]明显长于R组[(152.6±27.6)min](P<0.05)。D组术后镇痛药需求亦较R组低(P<0.05)。结论小剂量右美托咪定复合罗哌卡因鞘内注射,在老年患者TURP手术中,运动阻滞起效时间更快、感觉和运动阻滞持续时间延长;术后镇痛药物需求减少,并能维持血流动力学稳定,不增加恶心、呕吐、寒颤等不良反应;且无神经损害。

Objective To investigate the effects of low dose dexmedetomidine combined with ropivacaine in spinal anesthesia for elderly patients during TURP surgery.Methods Sixty elderly patients with elective TURP were randomly divided into group D and group R,with 30 patients in each group.Group D was intrathecally injected with 5μg dexmedetomidine hydrochloride combined with 10 mg 0.5%ropivacaine hydrochloride,while group R was intrathecally injected with 10 mg 0.5%ropivacaine hydrochloride.Intraoperative non-invasive mean arterial pressure(MAP),heart rate(HR)and pulse oxygen saturation(SpO_(2))were monitored.The onset time and duration of sensory and motor block,postoperative VAS score,postoperative analgesic drug demand,and the incidence of adverse reactions such as nausea,vomiting,hypotension and bradycardia were recorded.Results There were no significant differences in MAP,HR and SpO_(2)between two groups(P>0.05).Even though the onset time of sensory block was earlier in group D than in group R,but there was no statistical difference(P>0.05).Compared with group R,the highest plane of sensory block was different in Group D(P<0.05).In terms of duration of sensory block,the duration of two segments of sensory block resolution in group R[(89.3±6.5)min]was earlier than that in group D[(111.2±38.1)min](P<0.05),and the duration of sensory block resolution in group D[(286.7±43.2)min]was longer(P<0.05).In terms of exercise block,the onset time of exercise block in group D[(3.2±0.8)min]was shorter than that in group R[(3.9±1.3)min](P<0.05).The duration of motor block in group D[(242.7±33.7)min]was significantly longer than that in group R[(152.6±27.6)min(P<0.05).The demand of postoperative analgesics decreased in group D(P<0.05).Conclusion Application of low dose dexmedetomidine combined with ropivacaine in elderly patients duing TURP surgery can shorten the onset time of motor block and extend the duration of sensory and motor block.It also can reduce the need for postoperative analgesic and maintain hemodynamic stability without other adverse reactions such as nausea,vomiting,chills and nerve damage.