右美托咪定混合罗哌卡因用于患者硬膜外麻醉的效果  

Efficacy of dexmedetomidine mixed with ropivacaine for epidural anesthesia

作　　者：韩传宝[1] 蒋秀红[1] 周钦海[1] 丁正年[1] 

机构地区：[1]南京医科大学第一附属医院麻醉科,210029

出　　处：《中华麻醉学杂志》2015年第10期1251-1253,共3页Chinese Journal of Anesthesiology

摘　　要：目的 评价右美托咪定混合罗哌卡因用于患者硬膜外麻醉的效果.方法 择期拟行子宫切除术患者46例,ASA分级Ⅰ或Ⅱ级,年龄36～58岁,体重48 ～ 77 kg.采用随机数字表法,将其分为2组（n=23）：生理盐水混合罗哌卡因组（R组）和右美托咪定混合罗哌卡因组（DR组）.取L23间隙,常规行硬膜外穿刺术,DR组硬膜外注射0.75％罗哌卡因15 ml和右美托咪定1μg/kg混合液,R组硬膜外注射0.75％罗哌卡因15 ml和生理盐水2 ml混合液.记录感觉阻滞起效时间、最高阻滞平面和感觉阻滞时间.于硬膜外给药后30 min时记录改良Bromage分级、Ramsay镇静评分;记录术中牵拉反应程度、右美托咪定有关心血管事件和呼吸抑制的发生情况;记录术后2h内硬膜外麻醉有关不良事件发生情况.结果 与R组比较,DR组感觉阻滞起效时间缩短,感觉阻滞时间延长,最高阻滞平面和Ramsay镇静评分升高,术中牵拉反应程度减轻,麻醉后寒战发生率降低（P＜0.05）,未见右美托咪定有关不良事件的发生.结论 硬膜外注射右美托咪定1 μg/kg可显著优化罗哌卡因用于患者硬膜外麻醉的效果.Objective To evaluate the efficacy of dexmedetomidine mixed with ropivacaine for epidural anesthesia in the patients.Methods Forty-six patients, of ASA physical status Ⅰ or Ⅱ , aged 36-58 yr, weighing 48-77 kg, scheduled for elective hysterectomy under epidural anesthesia, were randomly divided into 2 groups （n =23 each） according to the random number table： normal saline ＋ ropivacaine group （R group） and dexmedetomidine ＋ ropivacaine group （DR group）.Epidural anesthesia was performed at L2,3interspace.The catheter was inserted into the epidural space.A mixture of 0.75% ropivacaine 15 ml and dexmedetomidine 1 μg/kg was injected epidurally in DR group.A mixture of 0.75% ropivacaine 15 ml and normal sline 2 ml was injected epidurally in R group.The onset time of sensory block, maximum level of sensory block, and duration of sensory block were recorded.The modified Bromage scale, Ramsay sedation score and intraoperative traction reaction were assessed.The occurrence of dexmedetomidine-related cardiovascular events and respiratory depression, and epidural anesthesia-related adverse events within 2 h after operation was recorded.Results Compared with R group, the onset time of sensory block was significantly shortened, the duration of sensory block was prolonged, the maximum level of sensory block and Ramsay sedation score were increased, the degree of intraoperative traction reactions was lessened, and the incidence of shivering was decreased in DR group （P 〈 0.05）.No patients developed dexmedetomidine-related adverse events.Conclusion Epidural dexmedetomidine 1 μg/kg significantly optimize the efficacy of ropivacaine when used for epidural anesthesia in the patients.

关 键 词：右美托咪啶 酰胺类 麻醉 硬膜外 

分 类 号：R614[医药卫生—麻醉学]