右美托咪定在肥胖患者锁骨骨折内固定术中的镇痛镇静效果及不良反应分析  

Observation on the analgesic effect and adverse reaction of dexmedetomidine in clavicular fracture fixation surgery of obese patients

作　　者：周纲[1] 应婷婷[1] 李商庚[1] 陈玲阳[1] 

机构地区：[1]浙江省台州医院麻醉科,浙江临海317000

出　　处：《中国现代医生》2017年第18期112-115,共4页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2017KY162)

摘　　要：目的探讨右美托咪定在肥胖患者锁骨骨折内固定术中的镇痛镇静效果及不良反应。方法 80例患者均为本院2014年1月~2016年10月期间收治的锁骨骨折病例,所有患者BMI评价为肥胖,均行锁骨骨折内固定手术。根据前瞻性研究将80例患者分为观察组和对照组,每组40例。观察组40例患者给予右美托咪定,对照组患者给予咪达唑仑镇痛镇静。观察并记录两组患者麻醉前、切口时、骨折复位时、缝合时各个时间段血压、心率及血氧饱和度的变化情况,以两组患者术后不良反应发生率展开分析。同时,采用Ramsay评分对两组患者术后镇痛镇静情况进行评价。结果对照组患者麻醉前HR(82.3±6.4)次/min、SPO2(104.3±23.4)%、收缩压(123.5±14.2)mm Hg、舒张压(84.8±12.2)mm Hg,与观察组(84.6±8.8)次/min、(101.4±6.6)%、(125.4±13.0)mm Hg、(85.8±11.2)mm Hg比较无明显差异(P>0.05)。T1~T3期间,观察组患者血压、心率显著低于对照组,差异有统计学意义(P<0.05)。但两组T1~T3血氧饱和度无明显差异(P>0.05)。观察组术中1例出现心动过缓、1例术后有恶心的情况,不良反应发生率5%;对照组患者术中出现2例呼吸抑制、3例术后有恶心的感觉、1例呕吐,不良反应发生率15%,两组比较差异有统计学意义(P<0.05)。两组患者术后Ramsay评分比较,观察组(4.3±0.8)分显著优于对照组(3.0±0.5)分,差异有统计学意义(P<0.05)。结论针对锁骨骨折内固定手术肥胖患者,要特别注意使用不影响血流动力学、稳定性好、安全性高、镇痛镇静效果好的药物,右美托咪定在此次研究中的表现良好,可在临床推广使用。Objective To investigate the analgesic effect and adverse effects of dexmedetomidine in clavicular fracture fixation in obese patients. Methods 80 patients with clavicle fracture admitted in our hospital from January 2014 to October 2016 were chosen, and all people were obesity by BMI evaluation and underwent clavicular fracture internal fixation surgery. According to a prospective study, 80 patients were divided into observation group and control group, with 40 patients in each group. 40 patients in the observation group were given dexmedetomidine, and the control group was given midazotam for analgesia and sedation. The changes of blood pressure, heart rate and blood oxygen saturation in the two groups were observed and recorded before anesthesia, when incising, resetting the fracture and stitching and the incidence of adverse reactions after operation in the two groups was analyzed. At the same time, the Ramsay score was used to evaluate the postoperative analgesia and sedation of the two groups. Results Before anesthesia, there were no significant differences between the observation group and the control group in HR[（82.3±6.4） times/min vs （84.6±8.8）times/min], SPO2[（104.3±23.4）% vs （101.4±6.6）%], systolic blood pressure[（123.5±14.2） mmHg vs （125.4±13.0） mmHg] and diastolic blood pressure [（84.8±12.2） mmHg vs （85.8±11.2） mmHg]（P〉0.05）. During the period T1 T3, the blood pressure and heart rate were significantly lower in the observation group than those in the control group（P〈0.05）, but there was no significant difference in blood oxygen saturation between the two groups（P〉0.05）. In the observation group, 1 ease had bradycardia, 1 ease had nausea and the adverse reaction rate was 5%. In the control group, there were 2 eases of respiratory depression, 3 eases had nausea after operation and 1 ease of vomiting, and the incidence of adverse reactions was 15%, the difference between the two groups was statistically significant （P〈0.05）. The Ramsay sco

关 键 词：右美托咪定 肥胖 锁骨骨折内固定 镇痛镇静 

分 类 号：R614[医药卫生—麻醉学]