不同剂量右美托咪定用于腰硬联合麻醉下肢手术的术中镇静  

Different doses of dexmedetomidine used for sedation in lower limb operation under combined spinal-epidural anesthesia

作　　者：杨自娟[1] 张兴安[1] 胡渤[1] 邵伟栋[1] 徐波[1] 屠伟峰[1] 

机构地区：[1]广州军区广州总医院麻醉科,广州510010

出　　处：《中国新药杂志》2013年第3期326-330,共5页Chinese Journal of New Drugs

基　　金：广东省科技计划项目(2012B031800417)

摘　　要：目的:评估不同剂量右美托咪定用于腰硬联合麻醉下肢手术的镇静效应。方法:选择80例ASAⅠ～Ⅱ级择期腰硬联合麻醉下行下肢手术的患者。按右美托咪定负荷剂量不同,随机分为D1组(0.25μg.kg-1),D2组(0.5μg.kg-1),D3组(0.75μg.kg-1)和C组(0μg.kg-1),每组20例。麻醉平面调节至T10以下,麻醉效果完善后开始静脉泵注右美托咪定负荷剂量,给药时间为10 min,其后均以0.5μg.kg-1.h-1的速率持续泵注。记录给药前即刻(T0)、给药后5 min(T1),10 min(T2),30 min(T3),60 min(T4),90 min(T5)和术毕(T6)时的心率(HR)、脉搏血氧饱和度(SpO2)、平均动脉压(MAP)、Narcotrend指数(Narcotrend in-dex,NI)和Ramsay镇静评分及不良反应发生率。术后24 h随访患者应用DEX后至术毕期间的遗忘程度。结果:与C组及T0时比较,D2和D3组HR在T3,T4,T5,T6时均下降。D3组MAP在T1时增高;D2,D3组在T2～T6时NI下降,在T3～T6时Ramsay评分增加。术后24 h随访,D1～D3组顺行性遗忘程度高于对照组(P<0.05)。结论:给予右美托咪定负荷剂量0.5μg.kg-1后以0.5μg.kg-1.h-1速率维持,在给药30 min后能达到满意的镇静,术中血流动力学比较稳定且不良反应较小。故可用于腰硬联合麻醉下肢手术患者的术中镇静。Objective： To evaluate the efficacy of different doses of dexmedetomidine used for intraopera- tive sedation in lower limb operation under combined spinal-epidural anesthesia. Methods： According to loading dose of dexnledetomidine, 80 patients of ASA I 0II who underwent elective operation of lower limbs under com- bined spinal-epidural anesthesia were randomly divided into 4 groups. They were administered with 0 （control） , 0.25, 0.5 and 0.75 μg·kg^-1 of dexmedetomidine. When the effect of anesthesia was fixed, intravenous infusion of dexmedetomidine loading dose was started within 10 min, followed by a continuous infusion of 0.5 ~g＂ kg-l＂ h-1 to the end of the operation. At the time points of 5,10,30,60, 90 rain after dexmedetomidine dosing and the end of operation, HR, SpO2, MAP, Naocotrend index （NI） , Ramsay score and adverse effects were recorded. Postopera- tive oblivion extent was followed-up until 24 h after the operation. Results： Compared with the values before admin- istration and in control group, HR of patients in 0.5 and 0.75 μg·kg^-1 groups decreased at 10 ~ 90 min after do- sing and the end of operation; MAP in 0.75 μg·kg^-1 group increased at 5min after dosing; NI in 0.5 and 0.75 μg·kg^-1 groups decreased at 10 ~ 90 min after dosing and the end of operation and Ramsay score increased at 30 ~90 min after dosing and the end of operation. Postoperative 24 h follow-up showed that anterograde amnesia extent was higher in dexmedetomidine groups than in control group （ P 〈 0.05 ）. Conclusion： The loading dose （0.5 μg·kg^-1） of dexmedetomidine, followed by a continuous infusion of 0.5 μg·kg^-1· h^-1, can achieve satisfactory sedation and keep hemodynamic stable with less adverse effects. Thus, it can be used for sedation in lower limb operation under combined spinal-epidural anesthesia.

关 键 词：右美托咪定 腰硬联合麻醉 术中镇静 

分 类 号：R971.3[医药卫生—药品] R969.4[医药卫生—药学]