瑞芬太尼与右美托咪定在老年患者椎体成形术及椎体后凸成形术监护性麻醉中的临床效果比较  

Comparison of Clinical Efficacy of Remifentanil and Dexmedetomidine for Monitored Anaesthesia Care in Elderly Patients during theVertebroplasty and Kyphoplasty

作　　者：王浩[1] 韩利锋[1] 杨小波[1] 王娜[1] 李清军[1] WANG Hao;HAN Li- feng;YANG Xiao-bo;et al(Department of anes- thesia ,Yalin First Hospital ,Yulin 718000,China)

机构地区：[1]榆林市第一医院麻醉科,陕西榆林718000

出　　处：《中国实验诊断学》2018年第3期412-415,共4页Chinese Journal of Laboratory Diagnosis

摘　　要：目的比较瑞芬太尼与右美托咪定在老年患者椎体成形术及椎体后凸成形术监护性麻醉中的临床效果。方法选取2014年6月至2016年6月于我院监护性麻醉下拟行椎体成形术及椎体后凸成形术的老年患者104例为本研究试验对象,随机分为A、B两组,每组各52例。A组患者接受负荷剂量生理盐水,随后持续输注1.0-5.0μg/kg/h瑞芬太尼;B组患者接受负荷剂量0.3-0.4μg/kg右美托咪定,随后持续输注0.2-1.0μg/kg/h右美托咪定。记录患者在利多卡因浸润期(T1)、套管针插入时(T2)、骨水泥注入时(T3)及皮肤缝合时(T4)的平均动脉压(MAP)、心率(HR)、SpO2、呼吸频率(RR)及不良反应情况。结果 B组患者的MAP(如T1时,113.1±20.0vs 104.7±18.9mmHg)和HR(如T1时,81.3±10.6vs 76.3±8.5)水平明显高于A组,且差异具有统计学意义(P<0.05)。A组的SpO2显著低于B组,尤其T2期(96.1%±3.0%vs 98.0%±1.3%)和T3期(96.2%±3.0%vs 98.2%±1.6%)。A组患者的血氧不足(32.7%vs 13.5%,P=0.04)和呼吸抑制(40.4%vs7.7%,P=0.03)发生率显著高于B组。另外,A组无人出现疼痛,B组有10例患者出现疼痛加剧,额外接受芬太尼治疗。结论在老年患者椎体成形术及椎体后凸成形术监护性麻醉中,与瑞芬太尼相比接受右美托咪定患者的呼吸抑制程度、平均动脉压及心率均更低。Objective To compare the clinical efficacy of remifentanil and dexmedetomidine for monitored anaesthesia care in elderly patients during vertebroplasty and kyphoplasty.Methods 104 elderly patients undergoing vertebroplasty and kyphoplasty for monitored anaesthesia care in our hospital from June 2014 to June2016 were chosen in this study,and randomly divided into group A and B with each group 52 patients.Patients in group A received intravenous saline for the loading dose,followed by a continuous intravenous infusion of remifentanil at 1.0-5.0μg/kg/h;and patients in group B received intravenouis loading dose at 0.3-0.4μg/kg,followed by a continuous intravenous infusion of dexmedetomidine 0.2-1.0μg/kg/h.Mean arterial pressure,heart rate,SpO2,respiratory rate and adverse effects at lidocaine infiltration（T1）,trocar insertion（T2）,cement insertion（T3）,skin closure（T4）were recorded.Results MAP（such as at T1,113.1±20.0 vs 104.7±18.9 mmHg）and HR（such as at T1,81.3±10.6 vs 76.3±8.5）in group B were obvious higher than that in group A,with significantly statistical differences.SpO2 in group A was lower than that in group B,especially at T2（96.1%±3.0% vs 98.0%±1.3%）and T3（96.2%±3.0% vs 98.2%±1.6%）.The incidence of oxygen desaturation（32.7% vs 13.5%,P=0.04）and respiratory depression（40.4% vs7.7%,P=0.03）were higher in group A and that in group B.Additionally,no patients complained of pain in group A,whereas 7 patients in group B complained of pain and received additional fentanyl.Conclusion In the monitored anaesthesia care in elderly patients during the vertebroplasty and kyphoplasty,dexmedetomidine provided less respiratory depression,lower MAP and HR.

关 键 词：瑞芬太尼 右美托咪定 椎体成形术 椎体后凸成形术 监护性麻醉 

分 类 号：R614.24[医药卫生—麻醉学]