静脉输注右美托咪定辅助腰麻对老年患者髋关节置换术后镇痛的影响  

Effects of intravenous dexmedetomidine on postoperative pain relief after hip arthroplasty under spinal anesthesia in elderly patients

作　　者：李晓瑜[1] 吴国荣[1] 郑晋伟[1] 甘林光[1] 陈骏萍[1] 

机构地区：[1]宁波市第二医院麻醉科,315010

出　　处：《浙江医学》2016年第16期1362-1364,1377,共4页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划(2014KYB232)

摘　　要：目的观察静脉注射不同剂量右美托咪定辅助镇静对老年患者髋关节置换术后镇痛的影响。方法选择择期行髋关节置换术的老年患者（≥65岁）60例,ASAⅠ~Ⅱ级,随机分为3组。行蛛网膜下腔阻滞后,D1组予右美托咪定1μg/kg负荷剂量（15min输注完毕）,继以维持剂量0.2μg/（kg·h）至术毕;D2组予右美托咪定负荷剂量0.5μg/kg（15min输注完毕）,维持剂量0.2μg/（kg·h）;对照组（C组）予等体积的0.9%氯化钠静脉输注（方法同D1组）。术后48h内予氟比洛芬酯50mg12h内静脉注射＋曲马多50mg 2次/d口服常规术后镇痛,当术后VAS评分≥4分时,予肌肉注射曲马多100mg补救镇痛。评估术后2、6、12、24、36、48h视觉模拟评分（VAS）,记录术后48h内首次补救镇痛时间、补救镇痛率、镇痛满意度及围术期不良反应发生率。结果与C组相比,D1组、D2组患者术后6h静息VAS评分显著降低,术后48h内补救镇痛率降低,镇痛满意度较高,D1组术后首次补救镇痛时间明显延迟,差异有统计学意义（P〈0.05）。D1组与D2组之间镇痛情况无统计学差别（P〉0.05）。D1组、D2组低血压发生率较C组明显升高（P〈0.05）。3组患者心动过缓、呼吸抑制、恶心呕吐及寒战等不良反应发生率无显著差异（P〉0.05）。结论不同剂量右美托咪定辅助腰麻均能显著提高老年患者髋关节置换术后48h内的镇痛效果,0.5μg/kg负荷剂量发挥有效的辅助镇痛效果。Objective To investigate the analgesic effects of intravenous dexmedetomidine after hip arthroplasty under spinal anesthesia in elderly patients. Methods Sixty ASA Ⅰ or Ⅱ patients over 65 years scheduled to receive hip arthroplasty were randomly divided into D1, D2 and control groups. After the spinal anesthesia was performed, patients received a dexmedetomidine loading dose of 1μg/kg（group D1） or 0.5μg/kg（group D2） for 15 min, followed by an infusion of 0.2μg/kg/h until the end of the surgery, or a normal saline loading dose and an infusion of an equivalent volume of normal saline（control group）. In the first 48 h following surgery, patients were given with intravenous flurbiprofen axetil 50 mg q.12 h and oral tramadol50 mg b.i.d for postoperative analgesia. Injection of tramadol 100 mg was applied if their pain was ≥4 on the resting visual analogue scale（VAS）. The VAS scores, the analgesic needs at the first 48 h, degree of satisfaction, and complications patients were documented and compared among groups. Results Compared with the control group, The 6h- VAS score was lower and the analgesic needs at the first 48 h was less in group D1 and D2. Patients in groups D1 and D2 showed more satisfaction with pain relief. There were no significant differences among the 3 groups in complications except that there was a higher incidence of hypotension in groups D1 and D2. Conclusion Intraoperative infusion of dexmedetomidine for sedation in patients receiving spinal anesthesia can produce satisfactory postoperative analgesic effects after hip arthroplasty.

关 键 词：右美托咪定 蛛网膜下腔阻滞 老年 髋关节置换术 

分 类 号：R614[医药卫生—麻醉学]