不同剂量右美托咪定单次泵注对腰硬联合麻醉患者寒战发生及复苏舒适质量的影响

To investigate the effects of different doses of dexmedetomidine given to patients with spinal-epidural anesthesia on resuscitation shivering and resuscitation comfort

目的研究不同剂量右美托咪定（Dex）单次泵注对腰硬联合麻醉患者寒战发生、术中血流动力学变化及复苏期间舒适质量的影响。方法择期行腰硬联合麻醉术的患者200例（ASAⅠⅡ级）,用随机数字表法将患者分成4组,D1组、D2组、D3组（n=50）在麻醉诱导前予以Dex分别采用0.2、0.4、0.6μg/kg+生理盐水50m L混匀后静脉泵注,泵注时间保持在1520 min内;C组（对照组,n=50）则予以等量生理盐水静脉泵注,观察记录患者各个阶段时间:患者进入手术室后未麻醉前（T0）,进行Dex泵注后10 min（T1）、30 min（T2）、50 min（T3）、手术结束（T4）,记录患者进入麻醉恢复室（PACU）时平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（Sp O2）、呼吸频率（RR）、肛门温度（T）、寒战发生情况、Ramsay评分（RSS评分）、手术时间、输液量、冲洗量和苏醒康复舒适度等情况。结果 D1组、D2组、D3组患者单次静脉泵注Dex后T1、T2、T3、T4时点MAP与T0时点相比,变化幅度较小（P>0.05）。而D3组患者在静脉泵注Dex后HR显著降低（P<0.05）。各组内部进行比较,T1、T2、T3、T4时间点的Sp O2和RR与T0时点比较,差异无统计学意义（P>0.05）。寒战发生率D2组、D3组比C组明显降低（P<0.05）。D2组、D3组T1、T2、T3、T4时间点RRS评分高于C组（P<0.05）。结论 Dex单次静脉泵注能够明显降低腰硬联合麻醉患者寒战的发生率,提高患者的镇静评分,提高患者复苏期间优级舒适综合满意度,且无药物不良反应,其应用Dex最佳推荐剂量为0.4μg/kg于1520 min内泵注完毕,可在临床中选用。

Objective To study the effects of dexmedetomidine（ Dex） for epidural anesthesia on resuscitation shivering,intraoperative hemodynamics,and resuscitation comfort. Methods 200 patients with lumbar epidural anesthesia were randomly divided into control group（ Group A） and experimental groups（ Group B1,B2 and B3）; in which intravenous saline,and Dex by 0. 2 μg / kg,0. 4 μg / kg and 0. 6 μg / kg were given,respectively. Anesthesia classification,basic personal information,surgery time and postoperative fluid volume,flushing volume and et al. were recorded.Results There was no significant difference in mean arterial pressure in Group B1,B2 or B3 between T1,T2,T3 or T4 and baseline（ P > 0. 05）; while the heart rate in Group B3 was significantly reduced after injection of Dex（ P < 0. 05）. In all groups,there was no significant difference in Sp O2 or respiratory rate between T1,T2,T3 or T4 and baseline（ P >0. 05）. Compared with Group C,there was no significant difference in body temperature in Group B1,B2 or B3（ P >0. 05）. The Ramsay score in Group B2 and B3 were significantly higher than that in Group C（ P < 0. 05）. Conclusion Dex can significantly reduce the incidence of resuscitation shivering,also improve the patient’ s sedation scores,with no side effects.