布比卡因单独或联合右美托咪定腰麻用于全膝关节置换术的剂量-效应关系  

The dose-effect relationship of intrathecal bupivacaine co-administered with dexmedetomidine for total knee arthroplasty

作　　者：徐燕[1] 袁力勇[2] 

机构地区：[1]宁波市医疗中心李惠利医院麻醉科 [2]宁波市第六医院麻醉科

出　　处：《中国临床药理学与治疗学》2014年第7期789-794,共6页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：宁波市优秀中青年卫生技术人才项目(2007201)

摘　　要：目的：确定布比卡因（Bup）单独或联合右美托咪定（Dex）腰麻用于全膝关节置换术（TKA）的剂量-效应关系。方法：ASAⅠ～Ⅱ、CSEA下行TKA患者162名，随机分为B组、BD1组及BD2组，每组54名。按Bup腰麻剂量（6～11mg）不同，再分为6个亚组，注入不同剂量Bup、Bup联合2μg或4μg Dex。成功麻醉标准为腰麻后15min内感觉平面阻滞达T12、运动神经阻滞完善；有效抑制止血带疼痛反应标准为上止血带期间无疼痛感受。以Probit法计算单独或联合不同剂量Dex成功麻醉及有效抑制止血带疼痛反应Bup腰麻的ED50及ED95。结果：三组患者麻醉成功率相似。BD1组及BD2组开始术后镇痛时间明显晚于B组；B纽、BD1组、BD2组成功麻醉Bup腰麻的ED50及ED95相似；BD1组、BD2组有效抑制止血带疼痛反应的ED50分别为5．5mg、5．3mg，低于B组的7．2mg（P〈0．05）；ED95分别为8．2mg、7．9mg，低于B组的9．9mg（P〈0．05）。结论：蛛网膜下隙注入2μg或4μg Dex对TKA患者成功麻醉Bup腰麻的ED50、ED95没有影响，但能明显降低有效抑制止血带疼痛反应Bup的ED50、ED95。AIM： To determine the dose-effect relationship o.f intrathecal bupivacaine （Bup） co- administered with dexmedetomidine （Dex） for total knee arthroplasty （TKA）. METHODS： One hundred Sixty-two ASA Ⅰ -Ⅱ patients un- dergoing TKA with use of CSEA were enrolled in this study. Patients were randomely assigned into three groups： Group B （Bup）, Group BD1 （Bup plus 2 μg Dex） and Group BD2 （Bup plus 4 μg Dex）. Each group was further divided by Bup doses of 6-11 mg. Successful anesthesia and successful tourniquet pain blockade were de- fined. The ED50 and ED9s values for successful anesthesia and successful tourniquet pain block- ade were determined separately by Probit regres- sion analysis. RESULTS： The rate of successful anesthesia was not different among three groups. The time of start postoperative analgesi-a in Group BD1, Group BD2 was later than that in GroupB （P=0.036）, respectively. The rate of successful tourniquet pain blockade was dif- ferent among three groups. The ED50 and ED95 values for successful tourniquet pain blockade were significantly smaller in Group BD1 and BD2 than that in Group B （P〈0.05）. CONCLU- SION： Intrathecal Dex did not decrease the dose of intrathecal Bup required for successful anes- thesia for patients undergoing TKA. However, it reduced the dose required for tourniquet pain blockade.

关 键 词：布比卡因 右美托咪定 腰麻 止血带 疼痛 剂量-效应关系 

分 类 号：R730.55[医药卫生—肿瘤]