经皮穿刺椎间孔镜术中应用右美托咪定在局部麻醉中的镇痛镇静效果及安全性评价

Analgesic and Sedative Effect and Safety Evaluation of Dexmedetomidine in Local Anesthesia during Percutaneous Transforaminal Surgery

目的 评估局部麻醉下经皮穿刺椎间孔镜术中采用右美托咪定的镇痛镇静效果和使用的安全性。方法 选择该院在2020年6月—2021年6月期间接诊的90例择期行局部麻醉经皮穿刺椎间孔镜术的患者,根据随机数字表法进行分组,分为3组,高剂量右美托咪定组、低剂量右美托咪定组、生理盐水组各30例,将3组镇痛镇静效果与使用安全性进行对比。结果 在T1、T2、T3时点,低剂量右美托咪定组与高剂量右美托咪定组HR、MAP均低于生理盐水组,差异有统计学意义(P<0.05)。生理盐水组的利多卡因用量(23.88±1.56)mL高于低剂量右美托咪定组(20.87±1.72)mL,高于高剂量右美托咪定组(20.21±1.55)mL,差异有统计学意义(t=7.099、9.140,P<0.05)。生理盐水组的VAS评分(7.63±0.75)分高于低剂量右美托咪定组(5.44±0.56)分,高于高剂量右美托咪定组(5.09±0.85)分,差异有统计学意义(t=12.815、12.272,P<0.05)。生理盐水组Ramsay评分(2.60±0.52)分低于低剂量右美托咪定组(3.32±0.64)分,低于高剂量右美托咪定组(3.44±0.56)分,差异有统计学意义(t=4.782、6.020,P<0.05)。结论 局部麻醉经皮穿刺椎间孔镜术中使用右美托咪定麻醉的效果显著,值得推广。

Objective To evaluate the analgesic and sedative effect and safety of dexmedetomidine in percutaneous transforaminal surgery under local anesthesia.Methods Selected 90 patients who received local anesthesia percutaneous transforaminal surgery in this hospital from June 2020 to June 2021,and were divided into 3 groups according to the random number table method.The high-dose dexmedetomidint group,the low-dose dexmedetomidine group,and the normal saline group included 30 cases each.The analgesic and sedative effects and safety of the three groups were compared.Results At T1,T2,and T3,the HR and MAP of the low-dose dexmedetomidine group and the high-dose dexmedetomidine group were lower than those of the normal saline group,and the difference was statistically significant(P<0.05).The lidocaine dosage in the normal saline group was(23.88±1.56)mL higher than that in the low-dose dexmedetomidine group(20.87±1.72)mL,and higher than that in the high-dose dexmedetomidine group(20.21±1.55)m L,and the difference was significant(t=7.099,9.140,P<0.05).The VAS score of the normal saline group(7.63±0.75)points was higher than that of the low-dose dexmedetomidine group(5.44±0.56)points,and higher than that of the high-dose dexmedetomidine group(5.09±0.85)points,and the difference was statistically significant(t=12.815,12.272,P<0.05).The Ramsay score of the normal saline group(2.60±0.52) points was lower than that of the low-dose dexmedetomidine group(3.32±0.64)points,lower than that of the high-dose dexmedetomidine group(3.44±0.56)points,and the difference was statistically significant(t =4.782,6.020,P <0.05).Conclusion The effect of dexmedetomidine anesthesia in percutaneous transforaminal surgery under local anesthesia is remarkable,which is worthy of promotion.