右美托咪定对老年患者前列腺电切术中寒战反应的影响  

Effects of dexmedetomidine on chills during prostatectomy in elderly patients

作　　者：程鹏[1] 丁长青[2] 刘近坤 

机构地区：[1]江苏省丰县人民医院麻醉科,江苏丰县221700 [2]江苏省丰县人民医院影像科,江苏丰县221700 [3]江苏省丰县人民医院泌尿科,江苏丰县221700

出　　处：《中国现代医生》2017年第20期97-100,共4页China Modern Doctor

基　　金：江苏省徐州市第一批"徐州市医学青年后备人才"培养工程资助(徐卫科教[2014]3号)

摘　　要：目的观察右美托咪定对老年患者前列腺电切术中寒战反应的影响。方法选择ASAⅡ~Ⅲ级、年龄大于65岁、前列腺电切术患者50例,随机分为两组,盐酸右美托咪定组(D组)和生理盐水对照组(C组),每组25例。两组患者均选择腰硬联合麻醉,见脑脊液后注入0.5%布比卡因2 mL,麻醉平面控制在T10水平。D组在15 min内持续泵注右美托咪定1μg/kg作为负荷剂量,然后以0.6μg/(kg·h)的速度持续泵入,C组以同样速度泵注生理盐水,两组均在手术结束时停止泵注。术中持续监测患者的生命体征,记录患者术中出现寒战的情况。结果两组患者在年龄、体重、手术时间、术中灌洗量及术中输液量上无明显差异(P>0.05);两组患者麻醉前、腰麻后15min、手术开始后30 min及手术结束时SBP、DBP、SpO_2没有明显变化(P>0.05);D组的HR在腰麻后15 min、手术开始后30 min明显低于C组(P<0.05),同时这两个时点D组HR明显低于麻醉前(P<0.05);D组术中寒战的发生率及寒战程度明显低于C组(P<0.05)。结论术中使用右美托咪定可有效降低老年患者前列腺电切术中寒战的发生率及严重程度。Objective To observe the effect of dexmedetomidine on chills during prostateetomy in the elderly patients. Methods A total of 50 patients with ASA level Ⅱ -Ⅲ and older than 65 years old undergoing prostateetomy were selected. They were randomly divided into two groups, dexmedetomidine hydrochloride group （Group D） and normal saline control group （group C）, with 25 patients in each group. Combined spinal and epidural anesthesia was selected for both groups of patients. When the cerebrospinal fluid was observed, the injection of 0.5% 2 mL bupivacaine was given, and the anesthesia plane was controlled at the level of TI0. Group D was continuously given 1 p^g/kg dexmedetomidine for 15 min via pump as a load dose, and the injection was maintained at a rate of 0.6 txg/（kg.h）. Group C was given nor- mal saline via pump at the same rate. Both groups stopped the pump at the end of the procedure. Patients＂ vital signs were continuously monitored during the surgery, and chills during the surgery were recorded. Results There were no significant differences in age, body weight, operation time, intraoperative lavage volume and intraoperative transfusion volume between the two groups（P〉0.05）; there were no significant changes in SBP, DBP and SpO2 in the two groups be- fore anesthesia, 15 min after lumbar anesthesia, 30 min after surgery and at the end of the operation （P〉0.05）; the HR in group D was significantly lower than that in group C at 15 min after spinal anesthesia and 30 min after operation （P〈 0.05）. At the same time, the HR in group D was significantly lower than that before anesthesia （P〈0.05）; the incidence rate of chills and the degree of chills in group D were significantly lower than those in group C（P〈0.05）. Conclusion The application of dexmedetomidine during the surgery can effectively reduce the incidence rate and severity of chills in elderly patients during prostatectomy.

关 键 词：腰硬联合麻醉 右美托咪定 老年 寒战 

分 类 号：R735.2[医药卫生—肿瘤]