右美托咪定自控镇静在腰硬联合麻醉全子宫切除术中的应用  

Patient-controlled Sedation with Dexmedetomidine in Application of Combined Spinal Epidural Anesthesia for Panhysterectomy

作　　者：范国义 韩志强[2] FAN Guo-yi HAN Zhi-qiang(Department of Anesthesiology, Maternal and Child Health Hospital of the Inner Mongolia Autonomous Region, Hohhot 010020, China Department of Anesthesiology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China)

机构地区：[1]内蒙古自治区妇幼保健医院麻醉科,呼和浩特010020 [2]内蒙古医科大学附属医院麻醉科,呼和浩特010050

出　　处：《临床误诊误治》2016年第12期67-70,共4页Clinical Misdiagnosis & Mistherapy

基　　金：内蒙古自然科学基金项目基金(2013MS1139)

摘　　要：目的探讨右美托咪定自控镇静在腰硬联合麻醉全子宫切除术中的安全性和有效性。方法选取2013年1月—2015年12月在我院行腰硬联合麻醉全子宫切除术120例,按照随机数字表法分为右美托咪定组和对照组,每组各60例。两组均采用腰硬联合麻醉及基础麻醉,右美托咪定组在此基础上予盐酸右美托咪定4μg/ml进行自控镇静,首次负荷剂量为2 ml,单次剂量0.5 ml,锁定时间30 s,维持量为1.5 ml/h。比较两组术中吗啡及利多卡因用量、术中及术后心率和平均动脉压变化、手术时间和术中出血量及术后早期焦虑分量表评分和患者满意度等。结果与对照组比较,右美托咪定组在用药后5 min、10 min、30 min、手术结束时和术后6 h心率均显著降低(P<0.05),术中吗啡及利多卡因用量均减少(P<0.05),术后6 h状态焦虑分量表评分显著降低,患者满意度显著增加(P<0.05)。两组手术时间及术中出血量比较差异无统计学意义(P>0.05)。结论右美托咪定自控镇静有助于维持血流动力学稳定,减少腰硬联合麻醉下全子宫切除术中麻醉药品用量,改善术后早期焦虑状态。Objective To investigate effectiveness and safety of patient-controlled sedation with Dexmedetomidine in application of combined spinal epidural anesthesia for panhysterectomy. Methods A total of 120 patients undergoing panhys-terectomy during January 2013 and December 2015 were divided into Dexmedetomidine group （ n =60 ） and control group （n=60） according to random digits table method. All the patients were treated with combined spinal epidural anesthesia and basal anesthesia, while Dexmedetomidine group was added with patient-controlled sedation with 4 μg/ml Dexmedetomidine hydrochloride, and initial loading dose was 2 ml, and a single dose was 0. 5 ml, and locking time was 30 s, and the mainte-nance dose was 1. 5 ml/h. Intraoperative doses of Morphine and Lidocaine, intraoperative and postoperative changes of heart rate and mean arterial pressure, operation time, intraoperative bleeding loss, postoperative early anxiety score and patient sat-isfaction were compared between the two groups. Results Compared with those in control group, in Dexmedetomidine group, values of heart rate were significantly decreased at 5 min, 10 min and 30 min after the medication, the ending of surgery and 6 h after the operation （ P〈0. 05 ）; dosage of intraoperative Morphine and Lidocaine was decreased （ P〈0. 05 ）; score of state anxiety rating scales at postoperative 6 h was significantly decreased （P〈0. 05）;degrees of patient satisfaction were sig-nificantly improved （P〈0. 05）. There were no significant differences in operation time and intraoperative bleeding loss be-tween two groups. Conclusion Patient-controlled sedation with Dexmedetomidine can help maintain stable hemodynamics, reduce dosage of narcotic drugs and relieve early anxiety symptom.

关 键 词：右美托咪定 麻醉 硬膜外 子宫切除术 焦虑 血流动力学 

分 类 号：R614[医药卫生—麻醉学]