利多卡因复合右美托咪定静脉输注对术前BIS值及镇静的影响

Effects of lidocaine combined with dexmedetomidine infusion on BIS andsedation before operation in patients undergoing lower limb fractures

目的:观察利多卡因复合右美托咪定静脉输注对下肢骨折患者术前BIS值的影响。方法:选择硬膜外阻滞麻醉行下肢骨折手术患者80例,随机分为4组:利多卡因组(L组)、右美托咪定组(D组)、利多卡因+右美托咪定组(LD组)和对照组(C组),每组20例。手术开始前20 min L组、D组、LD组分别泵注利多卡因1.5 mg/kg、右美托咪定0.5μg/kg和利多卡因1.5 mg/kg复合右美托咪定0.5μg/kg,10 min输完;C组泵注等容量的生理盐水。记录患者给药前(T_0)、给药后5 min(T_1)、给药后10 min(T_(2))、给药后15 min(T_(3))和给药后20 min(T_(4))的BIS值、MAP、HR、SpO_(2),并记录各时点的镇静评分及镇静满意度。结果:T_(2)-T_(4)时D组和LD组BIS明显低于C组和L组(P<0.05),T_(2)-T_(4)时D组和LD组Ramsay评分明显高于C组和L组(P<0.05)。T_(2)-T_(4)时LD组BIS明显低于D组,Ramsay评分明显高于D组(P<0.05);T_(2)-T_(4)时D组和LD组HR明显低于C组和L组(P<0.05)。结论:利多卡因复合右美托咪定静脉输注较单独输注右美托咪定或利多卡因能进一步降低术前BIS值,镇静满意度高,且不抑制呼吸,对血流动力学影响小。

Objective:To observe the efficacy and safety of lidocaine combined with dexmedetomidine infusion on BIS before operation in patients undergoing lower limb fractures.Methods:A total of 80 patients and scheduled for undergoing lower limb fractures were enrolled.They were allocated into four groups according to randomized method:group L was received lidocaine infusion(1.5 mg/kg loading,10 min)20 min before operation.Group D was received dexmedetomidine infusion(0.5μg/kg loading,10 min)20 min before operation.Group LD was received lidocaine infusion(1.5 mg/kg loading,10 min),dexmedetomidine infusion(0.5μg/kg loading,10 min)20 min before operation,respectively.Group C was received the same volume of saline.The value of BIS,MAP,HR,SpO2,and Ramsay score at 5 min before administration(T0),5 min after administration(T1),10 min after administration(T2),15 min after administration(T3),20 min after administration(T4).Results:Value of BIS were significantly lower in groups D and LD than groups C and L at T2-T4(P<0.05).Ramsay scores were significantly higher in groups D and LD than groups C and L(P<0.05).Value of BIS was significantly lower and Ramsay score was significantly higher in group LD than group D at T2-T4(P<0.05).HR in was significantly lower groups D and LD than groups C and L at T2-T4(P<0.05).Conclusion:Intravenous infusion of lidocaine combined with dexmedetomidine can further reduce BIS value,improve sedation satisfaction,do not inhibit respiration,and has less effect on hemodynamics before operation.