右美托咪定复合布比卡因用于硬膜外麻醉的临床观察  

Dexmedetomidine Combined with Bupivacaine for Epidural Anesthesia

作　　者：喻劲松[1] 徐国海[2] 肖实[1] 

机构地区：[1]武警江西总队医院麻醉科,南昌330001 [2]南昌大学第二附属医院麻醉科,南昌330006

出　　处：《实用临床医学（江西）》2015年第3期33-35,48,共4页Practical Clinical Medicine

摘　　要：目的观察右美托咪定复合布比卡因用于硬膜外麻醉的临床效果。方法将80例择期在硬膜外麻醉下行子宫和(或)卵巢切除术患者按随机数字表法分为右美托咪定复合布比卡因组(D组)和布比卡因组(C组),每组40例。所有患者均未用术前药,入室后常规监测ECG、BP和SpO2,面罩吸氧,开放上肢静脉通路,输注乳酸钠林格液。患者先呈左侧卧位选择腰2—3椎间隙行硬膜外穿刺,给予2%利多卡因试验剂量3mL,观察5min无蛛网膜下隙阻滞征象后,D组经硬膜外腔注入0.75%布比卡因15mL+右美托咪定0.1μg·kg-1;C组单纯经硬膜外腔注入0.75%布比卡因15 mL。分别于给药前(T0)、用药后10 min(T1),手术开始后10 min(T2)、30 min(T3)、60min(T4)和手术结束时(T5)记录2组患者HR、MAP、SpO2变化及Ramsay镇静评分,观察2组患者麻醉起效时间、镇痛持续时间、感觉恢复时间及运动恢复时间。结果与C组比较:D组T1—T5的HR、MAP降低,Ramsay镇静评分升高,且麻醉起效时间缩短,镇痛持续时间、感觉恢复时间及运动恢复时间延长(均P<0.05);2组SpO2比较差异无统计学意义(P>0.05)。结论右美托咪定复合布比卡因较单纯布比卡因用于硬膜外麻醉时缩短麻醉起效时间,延长镇痛时间、感觉恢复时间及运动恢复时间,并能为患者提供良好的镇静效果,是一种安全有效的麻醉方法。ABSTRACT:Objective To observe the clinical efficacy of dexmedetomidine combined with bupi-vacaine for epidural anesthesia.Methods Eighty patients scheduled for hysterectomy or/and oo-phorectomy under epidural anesthesia were randomly assigned to receive bupivacaine alone(group C,n=40)or in combination with dexmedetomidine(group D,n=40).No patients received preop-erative medication.After arrival in the operating room,patients were given routine monitoring of electrocardiogram(ECG),blood pressure(BP)and oxygen saturation(SpO2 ),mask oxygen inhala-tion,upper extremity venous catheterization,and ringer’s lactate solution infusion.Patients were placed in the left lateral position and epidural puncture was performed at L2-3.Then,patients re-ceived a test dose of 3 mL of 2% lidocaine and were monitored for 5 minutes.After no signs of subarachnoid block were found,the group D was given epidural injection of 0.75% bupivacaine (15 mL)and dexmedetomidine(0.1 μg·kg-1 ),and the group C was only given epidural injection&nbsp;of 0.75% bupivacaine(15 mL).Heart rate(HR),mean arterial pressure(MAP),SpO2 and Ramsay sedation score were recorded before administration(T0 ),10 minutes after administration(T1 ),10 minutes after the beginning of operation(T2 ),30 minutes after the beginning of operation(T3 ),60 minutes after the beginning of operation(T4 ),and at the end of operation(T5 ).In addition,the on-set time and duration of anesthesia and time to sensory and motor recovery were observed in both groups.Results Compared with group C,HR and MAP were decreased,Ramsay sedation score was increased,onset time of anesthesia was shortened,and duration of analgesia and time to sen-sory and motor recovery were prolonged in group D at T1 -T5 (P <0.05).There was no signifi-cant difference in SpO2 between the two groups(P >0.05).Conclusion Dexmedetomidine com-bined with bupivacaine for epidural anesthesia can shorten the onset time of anesthesia,prolong the duration of analgesia and time to sensory and motor recovery,and provide a good sed

关 键 词：右美托咪定 布比卡因 硬脊膜外麻醉 妇科手术 

分 类 号：R614.42[医药卫生—麻醉学]