右旋美托咪啶和咪达唑仑对罗哌卡因腰部麻醉作用的影响  

The effects of intravenous dexmedetomidine and midazolam on spinal anesthesia with ropivacaine

作　　者：曾海波[1] 佟华丽[1] 

机构地区：[1]三峡大学仁和医院麻醉科,湖北宜昌443001

出　　处：《重庆医学》2012年第35期3715-3717,共3页Chongqing medicine

摘　　要：目的比较静脉注射右旋美托咪啶和咪达唑仑对经尿道前列腺切除患者罗哌卡因腰部麻醉阻滞时间、镇痛和镇静作用的影响。方法收集该院于腰部硬膜外麻醉下行经尿道前列腺切除术的患者75例,随机分为右旋美托咪啶组、咪达唑仑组和生理盐水组。所有患者在麻醉前5min,分别静脉注射右旋美托咪啶(0.5μg/kg)、咪达唑仑(0.05mg/kg)和生理盐水。记录感觉阻滞的最高平面、感觉和运动阻滞的消退时间,以及术后镇痛药的需要量和镇静状态。结果右旋美托咪啶组感觉阻滞的最高平面(T 4.3±0.5)高于咪达唑仑组(T 6.1±0.8)或生理盐水组(T 6.4±0.7),差异有统计学意义(P<0.01)。右旋美托咪啶组感觉阻滞平面消退两个节段的时间为(148±26)min,长于咪达唑仑组(108±36)min或生理盐水组(95±27)min,差异有统计学意义(P<0.01)。3组运动阻滞作用的持续时间差异无统计学意义(P>0.05)。与咪达唑仑组或生理盐水组相比,右旋美托咪啶组延迟首次需要镇痛药治疗的时间且降低镇痛药的需要量。右旋美托咪啶组和咪达唑仑组拉姆齐镇静评分值高于生理盐水组,差异有统计学意义(P<0.01)。结论静脉注射右旋美托咪啶可延长罗哌卡因腰部麻醉感觉阻滞作用时间,且可以获得额外的术后镇痛和镇静效果。Objective To compare the effects of intravenous dexmedetomidine and midazolam on the block duration,analgesia,and sedation of spinal anesthesia with ropivacaine in patients undergoing transurethral resection of the prostate.Methods We selected 75 patients who have been conducted transurethral resection of the prostate after spinal and epidural anesthesia,and randomized them to three groups： dexmedetomidine group,midazolam group and saline group.All of the patients received intravenous dexmedetomidine 0.5μg/kg,midazolam 0.05 mg/kg,or saline respectively 5 minutes before spinal anesthesia with ropivacaine.The maximum upper level of sensory block,sensory and motor regression times were recorded.Postoperative analgesic requirements and sedation were also recorded.Results Sensory block was higher with dexmedetomidine（T 4.3±0.5） than with midazolam（T 6.1±0.8,P0.001） or saline（T 6.4±0.7,P0.01）.Time for sensory regression of two dermatomes was（148±26） min in the dexmedetomidine group,longer（P0.01） than in the midazolam（108±36 min） or the saline（95±27 min） groups.Duration of motor block was similar in all groups.Dexmedetomidine also postponed the time to request for postoperative analgesia（P0.01 compared with midazolam and saline） and decreased analgesic requirements（P0.05）.The maximum Ramsay sedation score was greater in the dexmedetomidine and midazolam groups than in the saline group（P0.01）.Conclusion Our results show that intravenous dexmedetomidine could prolong spinal ropivacaine sensory blockade.It could also provide additional sedation and analgesia.

关 键 词：右美托咪啶 罗哌卡因 麻醉 脊椎 

分 类 号：R614[医药卫生—麻醉学]