NTI指导下右美托咪定联合CSEA在老年下肢手术中的应用  

Application of dexmedetomidine under the guidance of narcotrend index during combined spinal-epidural anesthesia for elderly patients with lower extremity surgery

作　　者：陶嘉斌 苏喆[1] 王艳[1] 徐珂嘉 王跃军 张光明[1] TAO Jia-bin;SU Zhe;WANG Yan;XU Ke-jia;WANG Yue-jun;ZHANG Guang-ming(Department of Anesthesiology,Tongren Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200336,Chin)

机构地区：[1]上海交通大学医学院附属同仁医院(上海市同仁医院)麻醉科,上海200336

出　　处：《实用药物与临床》2018年第7期778-781,共4页Practical Pharmacy and Clinical Remedies

摘　　要：目的探讨麻醉趋势指数(NTI)指导下小剂量右美托咪定(DEX)联合腰硬联合麻醉(CSEA)对老年下肢手术患者血流动力学及镇静的影响。方法将76例接受下肢手术的老年患者随机分为2组,各38例。两组均采用小剂量DEX联合CSEA,指导组、对照组分别采用NTI、警觉/镇静(OAA/S)评分调节DEX的输注速度。比较两组不同时点的血流动力学参数、NTI、OAA/S评分及术中不良反应的发生情况。结果与T_0时比较,指导组T_1～T_4时HR、SBP、DBP差异无统计学意义(P>0.05),且均优于对照组(P<0.05)。与T_0时比较,指导组T_1～T_4时NTI、OAA/S评分均降低,且T_2～T_4时NTI高于对照组,OAA/S评分低于对照组(P<0.05)。与对照组比较,指导组术中呼吸抑制的发生率降低(P<0.05)。结论 NTI指导下的小剂量DEX联合CSEA用于老年下肢手术,可提高DEX用量的准确性,达到良好的镇静效果,减少血流动力学波动和术中并发症。Objective To explore the influence of small dose of dexmedetomidine（DEX） under the guidance of narcotrend index（NTI） during combined spinal-epidural anesthesia（CSEA） on stress reaction and sedation for elderly patients with lower extremity surgery. Methods Totally 76 elderly patients who received lower extremity surgery were randomly divided into two groups,38 cases in each group. All the patients were given small dose of DEX during CSEA,and the infusion speed of DEX was adjusted in guidance group and control group according to NTI and alert/sedation（OAA/S） score,respectively. The hemodynamic parameters,NTI and OAA/S score at different time points,and the occurrence of adverse reactions between guidance group and control group were compared. Results HR,SBP and DBP didn＇t change significantly in guidance group during T1～ T4 compared those at T0（P〉 0. 05）,which were significantly better than those in control group（P〈 0. 05）. Compared with T0,the NTI and OAA/S score during T1～ T4 in guidance group were decreased; the NTI during T1～ T4 in guidance group was higher than that in control group,while the OAA/S score was lower than that in control group（P 〈0. 05）. The incidence of intra-operative respiratory depression in guidance group was lower than that in control group（P 〈0. 05）. Conclusion Small dose of DEX under the guidance of NTI during CSEA for elderly patients with lower extremity surgery can improve the accuracy of DEX dosage,achieve good sedative effect,and reduce hemodynamic fluctuations and intraoperative complications.

关 键 词：麻醉趋势指数 下肢手术 老年 右美托咪定 腰硬联合麻醉 

分 类 号：R614[医药卫生—麻醉学]