右旋美托咪定复合地佐辛行蛛网膜下隙阻滞在全髋置换手术患者中的应用  

The applications of subarachnoid block with dexmedetomidine compounding dezocine in total hip replacement surgery patients

作　　者：江婷婷[1] 马兴华[1] 贾洪峰[1] 王思媛[1] 周涛[1] 

机构地区：[1]西安交通大学医学院附属三二0一医院麻醉科,723000

出　　处：《检验医学与临床》2017年第10期1445-1447,1450,共4页Laboratory Medicine and Clinic

摘　　要：目的探讨右旋美托咪定复合地佐辛行蛛网膜下腔阻滞在全髋置换手术(THA)患者中的应用效果。方法选取2015年6月至2016年6月该院收治的120例美国麻醉医师协会(ASA)Ⅰ~Ⅱ级行择期手术的THA患者,根据随机数字表法将患者分为A组(n=40)、B组(n=40)、C组(n=40),其中A组行常规气管插管全身麻醉操作;B组行L_(2-3)间隙进入蛛网膜下腔麻醉,麻醉平面固定后泵注0.2mg地佐辛混合液3mL;C组在B组基础上复合泵注3μg右旋托咪啶混合液3.5mL。记录3组麻醉阻滞前5min(T0)、麻醉阻滞后10min(T1)、手术开始时(T2)、麻醉完成后1h(T3)、手术结束时(T4)的平均动脉压(MAP)、心率(HR)、血氧饱和度(SPO2)、呼吸末二氧化碳(PETCO2)等血流动力学指标及血浆肾上腺素(E)、去甲肾上腺素(NE)、丙二醛(MDA)水平。比较3种麻醉方式并发症发生情况。结果 3组患者在T1~T4时段MAP、HR、SPO2、PETCO2、E、NE、MDA水平较T0阶段显著升高(P<0.05),其中A组患者T1~T4时段MAP、HR、SPO_2、PETCO_2、E、NE、MDA水平较B组、C组患者显著升高(P<0.017),而B组、C组T1~T4时段MAP、HR、SPO2、PETCO2、E、NE、MDA水平比较差异无统计学意义(P>0.017)。A组患者认知功能障碍、恶心呕吐、躁动、寒战、呼吸抑制发生率高于B组、C组(P<0.017),而B组寒战、呼吸抑制发生率高于C组(P<0.017)。结论右旋美托咪定复合地佐辛行蛛网膜下腔阻滞麻醉能有效稳定THA患者血流动力学及减轻患者血管应激反应,其术后并发症发生率较低,值得临床推广应用。Objective To analyze subarachnoid block with dexmedetomidine compounding dezocine in total hip replacement surgery（THA） patients.Methods A total of THA patients graded ASAⅠ-Ⅱ were divided into group A （n=40）,group B （n=40） and C group （n=40） from June 2015 to June 2016.Group A were implemented with endotracheal intubation operation.Group B were anaesthetized in the gap of line L2-3,and after a fixing,intermixture of 0.2 mg dezocine 3 mL was pumped.Group C were treated with 3 μg of mixed solution of miconazole 3.5 mL.The levels of mean arterial pressure （MAP）,heart rate （HR）,oxygen saturation （SPO2）,end-tidal carbon dioxide （PETCO2） and other hemodynamic parameters and plasma epinephrine （E）,norepinephrine （NE）,malondialdehyde （MDA） of three groups at 5 mins （T0） before anesthesia,10 mins after anesthesia （T1）,at the start of surgery （T2） and 1 h （T3） after completion of anesthesia,the end of the surgery （T4）.The anesthetic complications occur of three groups were compared.Results The levels of MAP,HR,SPO2,PETCO2,E,NE and MDA in T1 to T4 time were significantly higher than T0 stage （P〈0.05）,which of the group A were significantly higher than that of group B and group C.The levels of MAP,HR,SPO2,PETCO2,E,NE and MDA in T1 to T4 time were not statistically significant between group B and group C （P〉0.017）.The rates of cognitive disorders,nausea,vomiting,restlessness,chills and respiratory depression of group A were significantly higher than group B and group C （P〈0.017）,and the incidences of chills and respiratory depression of group B were significantly higher than that of groups C （P〈0.017）.Conclusion Subarachnoid block dexmedetomidine compounding dezocine spinal anesthesia could effectively stabilize hemodynamics THA patients and reduce patient stress and blood vessels,it has lower incidence of postoperative complications,which is worthy of promotion application.

关 键 词：右旋美托咪定 地佐辛 蛛网膜下腔阻滞 全髋置换手术 

分 类 号：R442.2[医药卫生—诊断学]