重比重与等比重布比卡因蛛网膜下腔阻滞麻醉对Narcotrend引导右美托咪定镇静效果的影响  

Effects of hyperbaric or isobaric bupivacaine on Narcotrend guided sedation with dexmedetomidine in subarachnoid block

作　　者：吴芳[1] 龚发贤 赵万里[1] 杨海燕[1] 

机构地区：[1]宁夏医科大学总医院麻醉科,宁夏银川750004

出　　处：《上海医学》2015年第10期759-762,共4页Shanghai Medical Journal

摘　　要：目的比较重比重与等比重布比卡因蛛网膜下腔阻滞麻醉对Narcotrend引导右美托咪定(Dex)镇静效果的影响。方法选择2012年11月—2013年5月在妇科择期行开腹子宫全切除术的患者48例,美国麻醉医师协会分级Ⅰ或Ⅱ级,随机分入重比重布比卡因蛛网膜下腔阻滞麻醉组(重比重组,10%葡萄糖溶液1mL+0.75%布比卡因2mL)和等比重布比卡因蛛网膜下腔阻滞麻醉组(等比重组,0.75%布比卡因2mL+脑脊液1mL),每组24例。调整药物注射速度以控制无痛平面为T6至T8。平均动脉压(MAP)下降>基础值的30%时予静脉注射麻黄素6mg,心率下降至<50次/min时予静脉注射阿托品0.5mg。两组均在阻滞平面固定后,静脉注射Dex负荷剂量0.5μg/kg,之后以0.6μg·kg^(-1)·h^(-1)持续泵入。术中每次上调或下调Dex泵入量0.2μg·kg^(-1)·h^(-1),以维持Narcotrend指数为70~80。记录患者的Dex初始用量(镇静开始至Narcotrend指数为70时的Dex剂量)和总用药量。分别于入手术室时、手术切皮、牵拉腹腔时、手术结束时各时间点,记录患者的心率、呼吸频率、MAP和脉搏血氧饱和度(S_pO_2)。记录患者的手术时间和镇静时间。记录使用麻黄素和阿托品的患者比例,以及输液量和出血量。结果两组间手术时间、镇静时间、Dex初始用量、使用麻黄素和阿托品的患者比例、输液量、出血量的差异均无统计学意义(Ρ值均>0.05),重比重组Dex总用量显著少于等比重组(P<0.05)。两组间患者围术期各时间点的心率、呼吸频率、MAP和S_pO_2的差异均无统计学意义(Ρ值均>0.05)。结论与等比重布比卡因相比,重比重布比卡因蛛网膜下腔阻滞麻醉可减少Narcotrend引导Dex镇静时Dex的总用量,但不能减少Dex的初始用量。Objective To compare the effect of subarachnoid block anesthesia with isobaric versus hyperbaric bupivacaine on Narcotrend guided sedation with dexmedetomidine. Methods Forty-eight patients, American Society of Anesthesiologists （ASA） physical status Ⅰ or Ⅱ, receiving selective uterus total resection between November 2012 and May 2013 were randomly divided into two groups （n = 24）. Subarachnoid block anesthesia was performed by 0.75% bupivacaine 2 mL plus 10% glucose solution in hyperbaric group and by 0.75% bupivacaine 2 mL plus cerebrospinal fluid 1 mL in isobaric group. The sensory block level was controlled at T6 -T8. Ephedrine 6 mg was intravenously given once mean arterial pressure （MAP） was decreased by 30% of baseline. And atropine 0.5 mg was intravenously given when heart rate was less than 50 per minute. After the block level was stable, 0.5 μg/kg dexmedetomidine was intravenously administered followed by a maintenance dose of 0.6μg·kg^-1·h^-1 Narcotrend index （NI） maintained between 70 to 80 by up-regulating or downregulating dexmedetomidine 0.2μg·kg^-1·h^-1each time during surgery. The onset dose （from the beginning of sedation to NI being 70） and total dose of dexmedetomidine, the duration of surgery and sedation were recorded. Heart rate, espiratory frequency, MAP and blood oxygen saturation of pulse （SpO2） were measured before surgery, at the beginning of incision, at the opening of abdominal cavity and at the end of the surgery. Theapplication of ephedrine and atropine, and intraoperative transfusion and blood loss were evaluated. Results There were no significant differences in terms of the duration of surgery or sedation, the onset dose of dexmedetomidine, the application of ephedrine or atropine, the volume of intraoperative transfusion or blood loss between two groups （all P〉0.05） ; neither were heart rate, espiratory frequency, MAP or SpO2 between groups （all P〉0.05）. However, the total dose of dexmedetomidine in the hyperbaric group was signific

关 键 词：重比重 等比重 蛛网膜下腔阻滞麻醉 NARCOTREND指数 右美托咪定 

分 类 号：R614[医药卫生—麻醉学]