全身麻醉联合胸段硬膜外注射右美托咪定用于单肺通气全麻患者临床效果观察  

Clinical Effects of General Anesthesia Combined Epidural Dexmedetomidine Injection in Patients with One-lung Ventilation

作　　者：肖少华[1] 王伶俐[1] 潘云[1] 常洁[1] 夏敏[1] 

机构地区：[1]湖北省荆门市第一人民医院麻醉科,湖北荆门448000

出　　处：《湖北医药学院学报》2013年第5期421-425,共5页Journal of Hubei University of Medicine

摘　　要：目的:探讨胸段硬膜外腔注射右美托咪定用于单肺通气胸外科手术全麻患者临床效果观察。方法:60例择期行胸科手术患者,美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级,随机分为右美托咪定复合罗哌卡因组(D组,n=30)和罗哌卡因组(L组,n=30)。两组患者均于T6~7间隙硬膜外腔穿刺置管后常规静脉全麻诱导并维持,硬膜外腔用药:D组:0.75%罗哌卡因10 mL+右美托咪定1μg/kg+0.9%氯化钠溶液配制成20 mL;L组:0.75%罗哌卡因10 mL+0.9%氯化钠溶液配制成20 mL。两组均间断给予,每小时推注5 mL。记录血气、血流动力学变化、OAA/S评分、对应的Narcotrend指数(NTI)及术后VRS记录疼痛评分,并观察术中知晓、苏醒期躁动、恶心呕吐等不良反应。结果:与L组患者相比,D组患者单肺通气时PaO2下降不明显(P<0.05),重度疼痛例数及芬太尼使用剂量明显减少(P<0.05),躁动发生率也显著降低(P<0.05)。两组患者ICU镇静水平相同。L组有3例患者(8%)出现术中知晓。结论:行胸科手术单肺通气麻醉,硬膜外腔注入右美托咪定既可减少患者麻醉药用量、提高术中氧分压,又能降低术中知晓发生率,并提高术后疼痛阈值。Objective To investigate the clinical effects of dexmedetomidine epidural administration on general anesthesia patients with one-lung ventilation during thoracic surgery. Methods Sixty ASAⅠ ~ Ⅱ patients were randomly divided into two groups,dexmedetomidine combined ropivacaine group( group D,n = 30) and ropivacaine group( group L,n = 30). The catheters were punctured at T6 ~ 7epidural space of all patients,then the conventional intravenous anesthesia were inducted and maintained. The epidural dosage regimen of group D were 0. 75% ropivacaine 10 mL + Dexmedetomidine 1 μg / kg + 0. 9%saline mixed into 20 mL,group L were 0. 75% ropivacaine 10 mL + 0. 9% saline mixed into 20 mL. Every 5 mL solution was injected at intervals of 1 hour. The blood gas,hemodynamic changes,OAA / S score,corresponding Narcotrend index( NTI) and postoperative verbal rating scale( VRS) for pain were recorded. Intraoperative awareness,restlessness in analepsia stage,nausea,vomiting and other adverse reactions were observed. Results Compared with group L,PaO2decreased slightly during one-lung ventilation( P < 0. 05),cases of severe pain,consumption of fentanyl and incidence of restlessness were all significantly decreased in patients of group D( all P < 0. 05). Patients of two groups were at the same level of sedation in ICU. Intraoperative awareness was happened in 3 cases( 8%) of group L. Conclusion General anesthesia patients undergone thoracic surgery with one-lung ventilation,epidural dexmedetomidine administration can decrease the consumption of anesthetics,improve the intraoperative oxygen partial pressure,reduce the incidence of intraoperative awareness and improve the threshold of postoperative pain.

关 键 词：右美托咪定 硬膜外腔 单肺通气 术中知晓 术后疼痛 

分 类 号：R614[医药卫生—麻醉学]