右美托咪定在椎管内麻醉术中的临床价值探析

Discussion of the clinical value of dexmedetomidine in the patients with treatment of epidural anesthesia

目的:对比分析右美托咪定与常用麻醉辅助药对椎管内麻醉术患者的应激反应及血流动力学的影响。方法:分析2016年4月~2016年10月在我院接受椎管内麻醉术治疗的126例患者的临床资料。随机将入选者均分成观察组(右美托咪定,42例)、对照组1(咪达唑仑,42例)和对照组2(丙泊酚,42例)三组。比较三组患者的一般资料、不同时间点血流动力学(包括平均动脉压MAP及心率HR)、听觉诱发电位指数(AAI)及皮质醇(Cor)水平。结果:三组患者的一般资料无显著统计学差异。用药后10min(T1)、用药后30min(T2)、用药后60min(T3)、手术结束时(T4)三组患者的MAP、AAI水平均明显低于同组用药前(T0)时;T3、T4时观察组及对照组2的MAP、HR水平均明显低于对照组1。T3时观察组与对照组1患者的AAI值均明显低于对照组2。T3、T4时三组患者的Cor水平均明显低于T0时;T3、T4时观察组患者Cor水平均明显低于同时点的对照组1、对照组2。观察组患者术后不良反应(包括恶心呕吐、呼吸抑制、头晕等)发生率(7.1%)明显低于对照组1(23.8%)、对照组2(26.2%)。结论:椎管内麻醉术采用右美托咪定辅助麻醉,不仅镇静作用良好,而且还可以显著抑制应激反应,安全有效,值得推广。

Objective Our retrospective study was aimed to compare and analyze the effects of dexmedetomidine and other commonly used anesthetic auxiliary drugs on the stress response and hemodynamics of the patients with treatment of epidural anesthesia. Methods Clinical data of 126 patients received treatment of epidural anesthesia at our hospital from April, 2016 to October, 2016 was retrospectively analyzed. Patients included were divided into two groups at random, observe group(dexmedetomidine, 42 cases), control group 1(midazolam, 42 cases) and control group 2(propofol, 42 cases). The general information, the values of MAP, HR, AAI, Cor in three groups at different times were compared. Results The general information in three groups had no statistical difference. The values of MAP, AAI at T1, T2, T3, T4 in three groups were obviously lower than those at T0 in the same group. The values of MAP, HR in observe group and control group 2 at T3, T4 were obviously lower than those in control group 1 at the same time. The values of AAI in observe group and control group 1 at T3 were obviously lower than those in control group 2 at the same time. The levels of Cor at T3, T4 in three group were obviously lower than those at T0 in the same group. The levels of Cor at T3, T4 in observe group were obviously lower than those in control group 1 and control group 2 at the same time. The rate of adverse reaction in observe group(7.1%) was significantly lower than those in control group 1(23.8%) and control group 2(26.2%). Conclusion The dexmedetomidine used in epidural anesthesia patients may has better sedative effect and an effect on reducing the stress response. It's safety, which is worth promoting.