右美托咪定用于脊柱内镜下椎间盘摘除术病人镇静镇痛的剂量探讨  

EFFECT OF DEXMEDETOMIDINE AT DIFFERENT DOSAGE ON SEDATION AND ANALGESIA AFTER TRANSFORAMINAL ENDOSCOPIC DISCECTOMY

作　　者：张晓栋 丁海涛 赵洪亮 郝建华 郭正纲 马盼盼 ZHANG Xiao-Dong;DING Hai-Tao;ZHAO Hong-Liang;HAO Jian-Hua;GUO Zheng-Gang;MA Pan-Pan(Anesthesia and Operation Center,The First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Anesthesiology,The Fourth Medical Center of Chinese PLA General Hospital,Beijing 100048,China)

机构地区：[1]中国人民解放军总医院第一医学中心麻醉手术中心,北京100853 [2]中国人民解放军总医院第四医学中心麻醉科,北京100048

出　　处：《中国疼痛医学杂志》2019年第12期909-912,共4页Chinese Journal of Pain Medicine

基　　金：全身麻醉精确镇痛的研究，吴阶平基金(320.6700.1159)

摘　　要：目的:探讨右美托咪定用于脊柱内镜下椎间盘摘除术(transforaminal endoscopic discectomy,TED)病人的安全、有效剂量。方法:选择2015年5月至2016年5月解放军总医院第一附属医院择期行脊柱内镜下椎间盘摘除术病人60例,按随机数字表法分为对照组(C组)、右美托咪定1组(D1组)和右美托咪定2组(D2组)。每组20例。D1组,局麻前10 min,静脉泵入右美托咪定负荷剂量0.5μg·kg^-1,10 min内泵完,随后以0.4μg/(kg·h)速度泵注,维持至手术结束前30 min;D2组,局麻前10 min,静脉内泵入右美托咪定负荷剂量1μg·kg^-1,10 min内泵完,随后以0.4μg/(kg·h)速度泵注,维持至手术结束前30 min;对照组静脉注射等量的生理盐水。记录手术开始(T1)、打磨小关节时(T2)、神经松解时(T3)、术毕(T4)的平均动脉压(MAP)、心率(HR),并进行疼痛、镇静水平的评分,记录不良反应发生率(呼吸抑制、严重心动过缓),术后第2天评价病人满意度。结果:三组病人一般情况(性别、年龄、体重、手术时间等)无明显差异(P>0.05);与对照组比较,D1、D2组病人各时点的MAP明显降低,心率明显减慢(P<0.05);Ramsay镇静评分明显增高(P<0.05);VAS明显降低(P<0.05)。与D1组比较,D2组病人Ramsay镇静评分明显增高(P<0.05),而VAS差异无统计学意义。且随着右美托咪定剂量增加,需干预的心动过缓明显增加。三组病人无呼吸抑制发生(P>0.05)。结论:右美托咪定负荷剂量0.5μg/kg,维持剂量0.4μg/(kg·h)至手术结束前30 min用于脊柱内镜下椎间盘摘除手术可以更好地改善病人镇痛水平,提供适度镇静,提高围术期病人满意度,减少不良反应的发生。Objective:To investigate the effective and safe dosage of sedation and analgesia of dexmedetomidine on transforaminal endoscopic discectomy(TED)patients.Methods:Sixty patients undergoing lumbar disc herniation were randomly divided into three groups:Dexmedetomidine(D1,D2)groups and Control group.In Group D1,the patients received dexmedetomidine at a dosage of 0.5μg·kg^-1 by intravenous injection before local anesthesia followed by a continuous infusion at 0.4μg/(kg·h)till 30 mins before the end of operation;Group D2,the patients received dexmedetomidine at a dosage of 1μg/kg by intravenous injection before local anesthesia followed by a continuous infusion at 0.4μg/(kg·h)30 mins before the end of operation;The patients in control group were administered with the same amount of normal saline.The mean pressure(MAP),heart rate(HR)and pain,sedation score were recorded at the beginning of operation(T1),scour of the joints(T1),neurolysis(T3)and the end of operation(T4).The incidence of side effects were recorded(respiratory depression,severe bradycardia.).At the same time,total evaluations of patient satisfaction degree were done on the 2nd day postoperative.Results:There were no statistical difference in general conditions(sex,age,weight,time of operation)(P>0.05).Compared with control group,MAP,HR and VAS in group D1,D2 were significantly decreased(P<0.05).Ramsay Score in group D1,D2 were significantly better than control group at the same time point(P<0.05).Compared with group D1,Ramsay Score in group D2 were significantly higher at the same time point(P<0.05).The VAS were no statistically significant difference between two groups.Intervention bradycardia with dexmedetomidine given dose is increased significantly.No respiratory depression occurred in three groups(P>0.05).Conclusion:Dexmedetomidine 0.5 mg/(kg·h)followed by a continuous infusion at 0.4 mg/(kg·h)on TED acquired had analgesic effect and provided moderately calm,enhanced the degree of satisfaction in the perioperative period with less adverse ef

关 键 词：右美托咪定 镇静 镇痛 脊柱内镜 椎间盘摘除术 

分 类 号：R614[医药卫生—麻醉学]