不同剂量右美托咪啶预防腰硬联合麻醉下寒战反应的效果  

Efficacy of different doses of dexmedetomidine in preventing shivering in patients with combined spinal epidural anesthesia

作　　者：程李健[1] 郑丽花[1] 江秀清[1] 赵柯敏[1] 余洁[1] 余功敏[1] 兰允平[1] 邵雪泉[1] 

机构地区：[1]衢州市人民医院麻醉科

出　　处：《中国临床药理学与治疗学》2015年第2期203-207,共5页Chinese Journal of Clinical Pharmacology and Therapeutics

摘　　要：目的：探讨不同剂量右美托咪啶（Dex）预处理对腰硬联合麻醉下寒战反应的有效性、安全性及最佳剂量。方法：择期下腹部妇科手术的女性患者120例,ASAⅠ﹣Ⅱ级,年龄33~65岁,采用随机数字表法按术中右美托咪啶微泵维持用量分为4组：D1组、D2组、D3组及对照组C组（生理盐水20mL）。D1、D2、D3组在硬膜外给药结束后输注右旋美托咪啶负荷量1μg/kg,之后分别以微泵缓慢输注右美托咪啶0.2（D1组）、0.4（D2组）、0.6μg/kg（D3组）,C组输注同等容量生理盐水,关腹前停用。纪录患者自麻醉开始到手术结束后有无寒战、寒战发生时间、寒战级别、术中使用麻黄碱和阿托品的比率及并发症。采用BIS监测评估给药前（T0）、给药后5min（T1）、15min（T2）、30min（T3）及手术结束时（T4）患者镇静程度,纪录各时点的鼓膜温度。结果：4组患者的年龄、身高、体质量及手术时间、麻醉时间均无明显差别（P〉0.05）。4组患者各时点的心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）无明显差别（P〉0.05）。4组寒战发生率分别为43.3%、16.6%、6.7%及40%,4组寒战发生率有统计学差异（P〈0.05）。4组低血压的发生率分别为5%、7%、8%、8%,各组之间比较无统计学差异。D3组与D1、D2组比较,阿托品使用比率有明显上升（P〈0.05）。与C组比较,前3组术中各时点BIS值有统计学差异（P〈0.05）。各组患者的鼓膜温度与术前比较有统计学差异（P〈0.05）。结论：右美托咪啶预处理可明显降低腰硬联合麻醉下寒战反应的发生率,其机制可能与降低中央室寒战温度触发阈值有关。右美托咪啶微泵维持的适宜剂量为0.4μg/kg。AIM：To evaluate the efficacy of different doses of dexmedetomidine（dex）in preventing shivering in patients with combined spinal epidural anesthesia.METHODS：One hundred and twenty patients,ASA physical statusⅠ-Ⅱ,aged 33-65 yr,weighing 45-76 kg,undergoing elective gynecological operations with combined spinal epidural anesthesia,were randomly divided into 4group（n=30each）.Ⅰ-Ⅲgroups received i.v.infusion of dex of 0.2μg/kg,0.4μg/kg,0.6μg/kg at a rate of 0.05μg/kg respectively after combined spinal epidural anesthesia.Group C received normal saline in ten minutes.Mean arterial pressure,heart rate,BIS value and tympanic temperature were recorded before administration（T0）,5min（T1）,15min（T2）and 30min（T3）after dex and the end of surgery（T4）.The adverse event including nausea,vomiting,hypotension and usage of atropine were recorded.Level of sedation were assessed by BIS monitor and tympanic temperature were recorded in each point.RESULTS：The incidence of shivering were 43.3%,16.6%,6.7% and 40%.The incidence of hypotension were 5%,7%,8%,8%,the usage incidence of atropine were 2%,10%,20%and 2%,BIS value were significantly decreased in dex groups at T1-T4 when compared with those in group C（P〈0.05）.Incidence of nausea or vomiting had no significantly difference in all groups.Tympanic temperature of patients in all groups was significantly lower than the baseline level（P〈0.05）.CONCLUSION： Dexmedetomidine can significantly reduce the incidence of shivering in patients with combined spinal epidural anesthesia.The mechanism is concerned with lower core temperature triggering shivering threshold.The optimal maintain dose of dex is 0.4μg/kg.

关 键 词：右美托咪啶 腰硬联合麻醉 寒战 鼓膜温度 

分 类 号：R614[医药卫生—麻醉学]